González R, Jednak R, Franc-Guimond J, Schimke C M
Divisions of Pediatric Urology, University of Miami, Florida 33101, USA.
BJU Int. 2002 Dec;90(9):909-11. doi: 10.1046/j.1464-410x.2002.03036.x.
To review the results of artificial urinary sphincter (AUS) implantation combined with seromuscular colocystoplasty (SCLU) in the treatment of mixed neurogenic urinary incontinence in children.
Patients (27, six females) who had undergone SCLU were interviewed, and their charts and imaging studies reviewed retrospectively. Their urodynamic data were analysed and bladder capacity, end-filling pressure, safe capacity and percentage of expected capacity for age compared before and after surgery. Continence was defined as dryness between catheterizations or voiding with no need for protective pads.
The mean (sd) follow-up since the SCLU was 1.7 (1.1) years; continence was achieved in 24 of the 27 (89%) patients with no additional procedures. No significant upper tract changes developed. Bladder capacity, safe capacity for age and end-filling pressure were all improved significantly. There were two AUS erosions necessitating removal and in one patient the augmentation failed. Six patients early in the series developed an 'hourglass' deformity that required correction. Modifications to the technique to avoid this complication are discussed.
For children with neuropathic incontinence who require both augmentation of outlet resistance and bladder storage capacity, the combination of the AUS and SCLU effectively achieves continence with no upper tract deterioration. SCLU is also the preferred method of augmentation when adverse bladder changes occur after implanting the AUS.
回顾人工尿道括约肌（AUS）植入联合浆肌层结肠膀胱扩大术（SCLU）治疗儿童混合性神经源性尿失禁的结果。
对接受SCLU手术的患者（27例，6例女性）进行访谈，并回顾其病历和影像学检查。分析他们的尿动力学数据，并比较手术前后的膀胱容量、充盈末期压力、安全容量以及相对于年龄的预期容量百分比。尿失禁的定义为两次导尿之间保持干爽或排尿时无需使用防护垫。
自SCLU手术以来的平均（标准差）随访时间为1.7（1.1）年；27例患者中有24例（89%）在未进行其他手术的情况下实现了尿失禁。未出现明显的上尿路改变。膀胱容量、相对于年龄的安全容量和充盈末期压力均有显著改善。有2例AUS侵蚀需要移除，1例患者的膀胱扩大术失败。该系列早期有6例患者出现“沙漏”畸形，需要进行矫正。讨论了为避免这种并发症而对技术进行的改进。
对于需要同时增加出口阻力和膀胱储存容量的神经性尿失禁儿童，AUS和SCLU联合使用可有效实现尿失禁，且不会导致上尿路恶化。当在植入AUS后出现不良膀胱改变时，SCLU也是膀胱扩大术的首选方法。
