Hoebeke P, De Kuyper P, Goeminne H, Van Laecke E, Everaert K
Department of Pediatric Urology, University Hospital, Gent, Belgium.
Eur Urol. 2000 Oct;38(4):453-6. doi: 10.1159/000020323.
In order to evaluate the effects of bladder neck closure (BNC) for treatment of pediatric incontinence, on the quality of life of those children, we reviewed the files of 17 children who underwent this procedure during the last 5 years. Information on previous surgery before BNC, continence and complications after BNC and patient satisfaction are gathered.
During the study period, 17 children (9 male, 8 female) underwent BNC with continent diversion. Ten children (5 male, 5 female) suffered neurogenic incontinence in meningomyelocele, 5 children (4 male, 1 female) had bladder exstrophy, 1 girl suffered iatrogenic incontinence after treatment of an ectopic ureterocele and 1 girl suffered structural incontinence after pelvic fracture. Previous surgery for incontinence was done in 12 children with 36 procedures. Primary BNC was done in 5 children. For continent diversion the appendix was used in 13, the ureter in 2, a Monti procedure in 1, and an ileal valve in 1. In 9 children, ileal bladder augmentation was performed at the time of BNC. Four children were augmented before. Mean age at time of operation was 13.5 years. Mean follow-up is 35 months.
After BNC, all patients were completely dry. One girl suffered some stomal incontinence during the night. This disappeared after recent bladder augmentation. Patient satisfaction is extremely high after surgery. All patients feel happy with their stoma and do not regret the choice they made. As for complications, urinary tract infections were seen in 9 patients. Stomal complications were seen in 8 patients. Three patients had some difficulty with catheterization, which could be solved with dilatation. Appendiceal polyps, which could be removed under local anesthesia, were seen in 3 and stomal stenosis which needed re-intervention in 2. In 1 patient, three revisions of the stoma were done, in the other patient, two surgical corrections. Out of 8 patients showing stomal complications, only 2 needed revision under anesthesia. All complications are seen in the first 6 months after the continent diversion.
We present a series of patients who underwent BNC for treatment of incontinence. BNC is the ultimate bladder neck reconstruction. However, regarding the high success rate, the low complication rate and the high patient satisfaction, we must consider BNC as an important procedure for the reconstructive surgeon. If reconstruction fails, closure must be considered. Compared to most other procedures for bladder neck reconstruction, BNC gives the highest continence rate. Good patient compliance and strict medical follow-up of the upper tract is mandatory in these patients.
为了评估膀胱颈闭合术（BNC）治疗小儿尿失禁对这些儿童生活质量的影响，我们回顾了过去5年中接受该手术的17名儿童的病历。收集了BNC术前的手术史、BNC术后的控尿情况、并发症以及患者满意度等信息。
在研究期间，17名儿童（9名男性，8名女性）接受了带可控性尿流改道的BNC手术。10名儿童（5名男性，5名女性）患有脊髓脊膜膨出所致的神经源性尿失禁，5名儿童（4名男性，1名女性）患有膀胱外翻，1名女孩在治疗输尿管囊肿异位后出现医源性尿失禁，1名女孩在骨盆骨折后出现结构性尿失禁。12名儿童因尿失禁接受过先前的手术，共进行了36次手术。5名儿童进行了初次BNC手术。对于可控性尿流改道，13例使用阑尾，2例使用输尿管，1例使用蒙蒂手术，1例使用回肠瓣。9名儿童在BNC手术时进行了回肠膀胱扩大术。4名儿童在此之前进行了扩大术。手术时的平均年龄为13.5岁。平均随访时间为35个月。
BNC术后，所有患者均完全干爽。1名女孩夜间出现一些造口失禁。最近进行膀胱扩大术后，这种情况消失了。术后患者满意度极高。所有患者对自己的造口都很满意，不后悔所做的选择。至于并发症，9名患者出现尿路感染。8名患者出现造口并发症。3名患者在导尿时遇到一些困难，通过扩张可以解决。3名患者出现可在局部麻醉下切除的阑尾息肉，2名患者出现需要再次干预的造口狭窄。1名患者进行了3次造口修复，另1名患者进行了2次手术矫正。在8名出现造口并发症的患者中，只有2名需要在麻醉下进行修复。所有并发症均出现在可控性尿流改道后的前6个月内。
我们展示了一系列接受BNC治疗尿失禁的患者。BNC是最终的膀胱颈重建术。然而，鉴于其高成功率、低并发症发生率和高患者满意度，我们必须将BNC视为重建外科医生的一项重要手术。如果重建失败，必须考虑进行闭合术。与大多数其他膀胱颈重建手术相比，BNC的控尿率最高。这些患者必须有良好的患者依从性并对上尿路进行严格的医学随访。
