Experience of pediatric urogenital tract inserted objects: 10-year single-center study
Experience of pediatric urogenital tract inserted objects: 10-year single-center study
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DOI：
10.1016/j.jpurol.2019.05.038
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发表时间：
2019-10-01
影响因子：
2
通讯作者：
Song, H.
中科院分区：
文献类型：
--
作者：
He, Y.;Zhang, W.;Song, H.
介绍泌尿生殖道异物（FB）在儿童中很少报道，并且处理仍然具有挑战性。本研究的目的是回顾一个单一中心10年的泌尿生殖道FB经验。患者和方法作者回顾了怀疑患有泌尿生殖道FB并首次入院的儿童的记录，包括人口统计学特征，表现症状，诊断方法，和管理作者比较了手术策略在不同位置的FB和年龄，以及FB的位置在不同年龄组。ResultsTwo和39例进行了审查，并确认188保留泌尿生殖道FB（150名女孩和38名男孩）。近10年来发病呈逐年上升趋势，近4年主要集中在春季和夏季。发病高峰年龄为3-5岁和9-13岁。对20名患者进行了全身麻醉手术（图1）。阴道FB更可能需要日间手术，而膀胱FB需要在医院手术。年龄小于6岁的女性患者多为阴道型FB，年龄大于11岁的男性患者多为膀胱型FB。由于阴道比尿道短而宽，患有阴道FB的女孩通常通过日间手术治疗，而患有尿道FB的青春期男孩则通过医院手术治疗。当患者隐瞒FB插入史，有严重的尿路感染，或有既往手术史时，可能会发生误诊。超声检查有助于减少误诊。当患者在尿道下裂修补术后出现新的症状时，应考虑到FB，并排除尿道下裂修补术后的变化，如尿路结石。应根据FB的大小、性质和位置采用适当的手术技术，以完全切除FB，并尽量减少并发症，以减少继发性损伤。尖锐性FB可在消化系统、泌尿生殖系统和盆腔深部迁移。如果手术困难，针稳定的患者可以通过密切随访进行保守治疗。然而，有症状的患者应积极治疗。结论应提高对儿童泌尿生殖道FB潜在严重性的认识。适当的玩具和及时的性教育有助于预防儿童泌尿生殖道异物插入。针对特定情况选择适当的技术是减少继发性损伤的最佳方法，特别是对于FB（针）移位、磁性FB和术后FB的病例。
IntroductionUrogenital tract foreign bodies (FBs) have been rarely reported in children, and the management is still challenging.ObjectiveThe aim of this study is to review a 10-year experience with urogenital tract FBs in a single center.Patients and MethodsThe authors reviewed the records of children suspected with urogenital tract FBs and first admitted to the hospital, including demographic characteristics, presenting symptoms, methods of diagnosis, and management. The authors compared the surgery strategies in different locations of FBs and age, and the locations of FBs in different age groups.ResultsTwo hundred and thirty-nine cases were reviewed, and 188 were confirmed to retain urogenital tract FBs (150 girls and 38 boys). The number of the patients increased progressively in the last 10 years and mainly concentrated in spring and summer in the last 4 years. The peak ages were 3-5 years old and 9-13 years old. General anesthesia surgeries were performed on 20 patients (Fig. 1). Vagina FBs were more likely to require day surgery, whereas bladder FBs required surgery in hospital. Patients younger than 6 years were more likely to be girls with vagina FBs, and patients older than 11 years were more likely to be boys with bladder FBs.DiscussionUrogenital tract FBs in children is a great challenge. As the vagina is shorter and wider than the urethra, girls with vagina FBs are usually treated by day surgery and adolescent boys of urethra FBs are treated by hospital surgery. Misdiagnosis may occur when patients conceal FBs insert history, have severe urinary tract infections, or have previous surgery history. Ultrasonography helps to reduce misdiagnosis. FBs should be taken into consideration when patients have new symptoms after hypospadias repair, and postoperative changes of hypospadias repair, such as urinary calculi, have been excluded. Appropriate surgery techniques, based on the size, nature, and location of FBs, should be performed for complete removal of FBs with minimal complications to reduce secondary injury. Sharp FBs could be migrated among the digestive system, urogenital system, and deep pelvic. If the procedure is difficult, patients with a stable needle can be conservatively managed with close follow-up. Nevertheless, symptomatic patients should be treated actively.ConclusionThe awareness of potential severity of pediatric urogenital tract FBs should be raised. Appropriate toys and timely sex education help prevent children from urogenital tract FBs insertion. Selecting appropriate techniques for particular situations is the best way to reduce secondary injury, especially for cases with migrated FBs (needles), magnetic FBs, and postoperative FBs.