Evaluating Outcomes of Enterocystoplasty in Patients With Spina Bifida: A Review of the Literature
Evaluating Outcomes of Enterocystoplasty in Patients With Spina Bifida: A Review of the Literature
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DOI：
10.1016/j.juro.2008.08.050
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发表时间：
2008-12-01
影响因子：
6.6
通讯作者：
Wiener, John S.
中科院分区：
文献类型：
--
作者：
Scales, Charles D., Jr.;Wiener, John S.
目的：脊柱裂的泌尿系统并发症给患者带来了巨大的残疾和疾病负担。治疗的重点是膀胱，以实现维持正常肾功能和获得泌尿系统的主要目标。当药物治疗失败时，经常进行手术干预，包括肠膀胱成形术。然而，肠膀胱成形术的实践模式显示出显着的变化。在此背景下，我们研究了脊柱裂患者肠囊成形术的结果指标。材料和方法：在MEDLINE（R）中搜索关于脊柱裂患者肠囊成形术的文章。共识别出226篇文章，并对相关研究进行了手动审查。根据引用的参考文献search.Results：几乎所有的研究都是回顾性的，单一机构的病例系列相对较少的患者。肠膀胱成形术很少有统一或有效的结局指标，但报告的指标通常包括尿动力学、排尿和满意度参数。在尿动力学测量和尿动力学定义的机构间差异使得结果的比较变得困难。肠膀胱成形术后的并发症发生率是显着的，以及描述和主要相关的使用胃肠道段的尿液storages.Conclusions：医疗管理是脊柱裂人群的神经源性膀胱治疗的支柱。肠膀胱成形术仍然是一个重要的选择，以防止或扭转上尿路恶化，和/或改善或治愈社会上不可接受的尿失禁，尽管定义不明确的结果措施。适当的和有效的结果措施的发展可能使脊柱裂患者的泌尿外科护理更加统一，有效和安全。
Purpose: The urological complications of spina bifida impose a significant burden of disability and disease. Therapy is focused on the bladder to achieve the primary goals of maintaining normal renal function and attaining urinary continence. When medical management fails, surgical intervention, including enterocystoplasty, is frequently performed. However, practice patterns for enterocystoplasty show significant variation. Given this context, we examined outcome measures for enterocystoplasty in patients with spina bifida.Materials and Methods: A MEDLINE (R) search was performed for articles on enterocystoplasty in patients with spina bifida. A total of 226 articles were identified and manually reviewed for relevant studies. Additional articles were selected based on a cited reference search.Results: Almost all studies are retrospective, single institution case series of a relatively small number of patients. Few uniform or validated outcome measures for enterocystoplasty exist but reported measures typically include urodynamic, continence and satisfaction parameters. Interinstitutional variability in urodynamic measurements and in definitions of continence makes a comparison of outcomes difficult. The complication rate following enterocystoplasty is significant, well described and primarily related to the use of gastrointestinal segments for urine storage.Conclusions: Medical management is the mainstay of neurogenic bladder therapy in the spina bifida population. Enterocystoplasty remains an important option to prevent or reverse upper tract deterioration, and/or improve or cure socially unacceptable incontinence despite poorly defined outcome measures. The development of appropriate and validated outcomes measures may enable more uniform, effective and safe urological care of patients with spina bifida.