Effect of Failed Initial Closure on Bladder Growth in Children With Bladder Exstrophy
Effect of Failed Initial Closure on Bladder Growth in Children With Bladder Exstrophy
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DOI：
10.1016/j.juro.2011.05.067
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发表时间：
2011-10-01
影响因子：
6.6
通讯作者：
Gearhart, John P.
中科院分区：
文献类型：
--
作者：
Baradaran, Nima;Cervellione, Raimondo M.;Gearhart, John P.
目的：与成功的初次重建术相比，失败的膀胱外翻闭合可能会阻碍膀胱自然生长过程。通过测量出生后5年内连续的膀胱容量，我们比较了初次闭合失败和成功的儿童的膀胱生长率。材料和方法：我们使用一个批准的膀胱外翻数据库来识别和回顾1-6岁接受重复膀胱造影术的典型膀胱外翻患者。确定了两组患者--新生儿成功闭合(第1组)和初次手术失败后再闭合成功(第2组)。用广义线性混合模型来评价治疗组和年龄对膀胱生长的影响。结果：我们确定了第一组患者48例(75%男性)和第二组患者62例(71%男性)。第1组和第2组分别有60%和34%的患者行初次骨盆截骨术。术后2、4、5、6年，第1组患者的膀胱造影量明显大于第2组(p<；0.05)。与第1组(14.76cc/年)相比，第2组(9.38cc/年)的膀胱增长速度明显减慢(p=0.005)。结论：与成功关闭新生儿膀胱相比，初次膀胱外翻关闭失败的患者膀胱造影术容量明显减少，膀胱生长缓慢。这些数据清楚地强调了安全、成功的一期闭合的重要性。
Purpose: Failed initial bladder exstrophy closure may hinder the natural course of bladder growth compared to successful primary reconstruction. By measuring successive bladder capacities within the first 5 years of life, we compared the rate of bladder growth in children with failed vs successful initial closure.Materials and Methods: We used an approved bladder exstrophy database to identify and review retrospectively patients with classic bladder exstrophy who underwent repeat cystograms between ages 1 and 6 years. Two groups of patients were identified-those with successful neonatal closure (group 1) and those with successful reclosure after an initial failed procedure (group 2). A generalized linear mixed model was fit to evaluate the impact of treatment group and age on bladder growth.Results: We identified 48 patients in group 1 (75% male) and 62 in group 2 (71% male). Initial pelvic osteotomy was done in 60% of group 1 and 34% of group 2. Patients in group 1 had significantly larger cystographic capacity at 2, 4, 5 and 6 years after successful bladder closure compared to those in group 2 (p < 0.05). The bladder tended to grow at a significantly slower rate in group 2 (9.38 cc yearly) compared to group 1 (14.76 cc yearly, p = 0.005).Conclusions: Patients with initial failed bladder exstrophy closure showed significantly smaller cystographic capacities and slower bladder growth compared to those who underwent successful neonatal bladder closure. These data clearly underscore the importance of a secure, successful primary closure.