Complete primary repair of bladder exstrophy in children presenting late and those with failed initial closure: single center experience.
Complete primary repair of bladder exstrophy in children presenting late and those with failed initial closure: single center experience.
复制标题
对晚期就诊和初次闭合失败的儿童进行膀胱外翻的完全初级修复：单中心经验。
DOI：
10.1097/01.ju.0000179191.45671.3b
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Hany El
中科院分区：
文献类型：
--
作者：
A. Hafez;M. El;A. Shorrab;Hany El
目的
使用Mitchell技术的膀胱外翻完全一期修复术（CPR）得到了广泛的普及。我们介绍了一个单中心的经验，心肺复苏术在30名儿童膀胱外翻出现晚或失败后初步关闭。
材料和方法
1998年11月至2003年11月，45例患者接受了心肺复苏术的膀胱外翻使用米切尔的技术。所有22名男孩和8名女孩提出超过1岁进行了评估。在30例患者中，19例（63%）有外翻闭合失败的病史。手术时患者平均年龄为3.2岁（范围1 - 8岁）。所有儿童均行双侧髂前截骨术。所有患者在术前和术后3个月进行超声检查。在3个月时进行排尿性膀胱尿道造影，然后每年进行一次。尿失禁的定义为3小时或更长时间的干燥间隔。
结果
平均随访40个月（范围5 - 64）。5名儿童（17%）同时进行了肠膀胱扩大术。22名男孩中有17名（77%）的修复导致尿道下裂。拔除导尿管后，7例患者（23%）出现耻骨上漏尿，全部自行停止。30名儿童中有19名（63%）出现术后早期肾积水，并全部自行消退。6例患者（20%）有发热性尿路感染，保守治疗。膀胱输尿管返流23例（68%）。5例同时行膀胱扩大术的患者中，2例行膀胱颈闭合术，2例行膀胱颈重建术（BNR）。目前，5名患者均已脱水。其余25例患者的平均膀胱容量为90 ml（范围30 - 200），6例儿童（24%）膀胱破裂。6名女孩中有3名（50%）实现了尿失禁，而19名男孩中有3名（16%）实现了尿失禁。5例患者接受BNR，4例患者接受回肠膀胱成形术。其余14名患者正在等待BNR，有或没有膀胱扩大。
结论
对于迟发或初次闭合失败的儿童，膀胱外翻的CPR是可行的。17%的患者需要同时进行肠膀胱扩大术。手术导致77%的男孩尿道下裂。50%的女孩在没有随后的膀胱颈手术的情况下可以实现尿失禁。另一方面，大多数男孩（84%）需要BNR，无论是否隆乳。
PURPOSE
Complete primary repair (CPR) of bladder exstrophy using Mitchell's technique gained wide popularity. We present a single center experience with CPR in 30 children with bladder exstrophy presenting late or after failed initial closure.
MATERIALS AND METHODS
Between November 1998 and November 2003, 45 patients underwent CPR of bladder exstrophy using Mitchell's technique. All 22 boys and 8 girls presenting beyond the age of 1 year were evaluated. Of the 30 patients 19 (63%) had a history of failed exstrophy closure. Mean patient age at surgery was 3.2 years (range 1 to 8). Bilateral anterior iliac osteotomies were performed in all children. Ultrasound was performed before surgery and 3 months thereafter in all patients. Voiding cystourethrography was obtained at 3 months and then annually. Continence was defined as dry intervals of 3 hours or more.
RESULTS
Mean followup is 40 months (range 5 to 64). Concomitant intestinal bladder augmentation was performed in 5 children (17%). The repair resulted in hypospadias in 17 of 22 boys (77%). Following catheter removal 7 patients (23%) had suprapubic urine leakage that ceased spontaneously in all. Early postoperative hydronephrosis was present in 19 of the 30 children (63%) and resolved spontaneously in all. Six patients (20%) had febrile urinary tract infection that was treated conservatively. Vesicoureteral reflux was present in 23 children (68%). Of the 5 patients treated with concomitant bladder augmentation 2 are continent, 2 underwent bladder neck closure and 1 underwent bladder neck reconstruction (BNR). All 5 patients are currently dry. The remaining 25 patients had a mean bladder capacity of 90 ml (range 30 to 200) with continence in 6 children (24%). Continence was achieved in 3 of 6 girls (50%) versus 3 of 19 boys (16%). Five patients underwent BNR with ileocystoplasty in 4. The remaining 14 patients are awaiting BNR with or without bladder augmentation.
CONCLUSIONS
CPR of bladder exstrophy is feasible in children presenting late or after failed initial closure. Concomitant intestinal bladder augmentation was required in 17% of our patients. The procedure resulted in hypospadias in 77% of the boys. Continence was achievable in 50% of the girls without subsequent bladder neck surgery. On the other hand, most boys (84%) will require BNR with or without augmentation.