根除性膀胱切除 (radical cystectomy) 的病患在特性情況下，接受迴腸人工正位膀胱重建 (ileal orthotopic bladder substitue, OBS)更能夠被病患所接受；主因是，這樣的術式更能夠保留外觀上的完整，以及生理功能上的禁尿功能。在這些病患的追蹤期間，是否能夠自主解尿，是否保留正常的腎臟功能和以及性功能的維持，對於術後的生活品質是很重要的追蹤項目。骨盆腔的交感神經纖維，在休息時維持尿道的張力扮演重要的角色；因此在一些機器手臂輔助式根除性膀胱切除的研究發現，在施行人工膀胱重建時同時施行神經保留，對於短期或者中期的禁尿功能都是有幫助的。而長期的禁尿功能，以及性功能影響，是目前尚待研究的有趣議題。

本篇研究為了追蹤長期的結果 (平均追蹤期大約169個月)，針對手術後存活超過十年的病患去做分析。本研究將180位病人分成三組，一組沒有接受神經保留，一組接受單側神經保留，一組接受雙側神經保留。追蹤時間點為術後1,3,6個月，之後每半年追蹤直到滿五年。禁尿評估是採用ICIQ-UI-SF問卷，而性功能評估是採用IIEF-15問卷。達到禁尿的定義為，一天所需要的尿片小於等於一片。勃起功能維持的定義是，能夠成功且維持勃起來進入陰道性交 (IIEF-15問卷上問題2的分數要大於2分)。結果發現，在保留神經組的日間禁尿功能維持是未保留組別的兩倍 (OR 2.08, p=0.04) 。在維持夜間禁尿功能方面，保留組是未保留組別的3.5倍 （OR 3.49, p=0.007)。在術後五年的追蹤期間內，有一半以上的病人 (52%) 可以維持足夠的勃起功能來進行性交。勃起功能維持率在為保留神經組是10%， 單側保留神經組是52%，雙側神經保留組是72%。本研究結論認為，在術後存活超過十年的膀胱癌病患接受過根除性膀胱切除併原位膀胱重建術，同時施行神經保留，可以有效維持禁尿功能；而且這樣的好處在病患年紀增長之後會更加明顯。雖然缺少隨機分組，可能選擇比較健康的病患來進行神經保留會造成偏差；不過文章嘗試探討日間、夜間禁尿功能，以及勃起功能維持的長期追蹤，是個值得參考的觀察點。期待未來有更多隨機分組的研究來探討，對於癌症控制以及術後生活品質影響的直接証據。

Objective
To analyse urinary continence in long-term survivors after radical cystectomy (RC ) and orthotopic bladder substitution (OBS) according to attempted nerve-sparing (NS ) status.

Patients and Methods
We analysed 180 consecutive patients treated at our department between 1985 and 2007, who underwe nt RC with OBS, and survived ≥ 10 years after RC. We stratifi ed patients by attempted NS status and evaluated continence outcomes using descriptive statistics and Cox proportional hazards regression models. A secondary analysis evaluated erectile function as a quality control for attempted NS.

Results
The median (interqu artile range [IQR]) age at RC was 62 (57~71) years. Of 180 patients, attempted NS status was none in 24 (13%), unilateral in 100 (56%), and bilateral in 56 (31%). After a median (IQR) follow -up of 169 (147~210) months, 160 (89%) patients were continent during day time and 124 (69 %) during night-time. In multivariable analysis, any degree of attempted NS was significantly as sociated with daytime continence (odds ra tio [OR] 2.08, 95% confidence interval [CI] 1.05–4.11; P = 0.04). Correspondingly, any attempted NS was significantly associated with ni ght-time continence (OR 2.51, 95% CI 1.08–5.85; P = 0.03). Recovery of erectile function at 5 years was also significantly associated with attempted NS ( P < 0.001).

Conclusion
Nerve-sparin g during RC and OBS was associated with better long-term continence outcomes. This becomes more apparent as the patients age with their OBS. We advocate a NS RC whenever an OBS is considered.