Miller David C, Bloom David A, McGuire Edward J, Park John M
Department of Urology, University of Michigan, Ann Arbor, 48109, USA.
J Urol. 2003 Oct;170(4 Pt 2):1606-8; discussion 1608-9. doi: 10.1097/01.ju.0000083801.04783.ff.
We describe our use of perineal urethrostomy to facilitate serial external sphincter dilations in a male child with high risk myelomeningocele.
A 5-month-old boy with lumbar myelomeningocele presented with poor bladder compliance, increased detrusor leak point pressure and high grade vesicoureteral reflux. Urodynamic parameters failed to improve with clean intermittent catheterization and anticholinergic therapy. Given the persistent risk to the upper urinary tract, perineal urethrostomy was performed to facilitate external sphincter dilation in a serial fashion.
The patient underwent 2 aggressive external sphincter dilations (30Fr) under direct vision. The second dilation was performed in the outpatient clinic without anesthesia. Subsequent cystometrographic evaluation revealed dramatic improvement in bladder storage properties with improved compliance and a safe detrusor leak point pressure. Moreover, followup imaging demonstrated complete resolution of vesicoureteral reflux.
Creation and maintenance of perineal urethrostomy is a valuable innovation in the treatment of some boys with high risk myelomeningocele. This easily reversible diversion allows aggressive, sequential external sphincter dilation and produces substantial improvements in bladder storage properties.
我们描述了如何使用会阴尿道造口术，以方便对一名患有高危脊髓脊膜膨出症的男童进行系列外括约肌扩张术。
一名患有腰骶部脊髓脊膜膨出症的5个月大男童，出现膀胱顺应性差、逼尿肌漏尿点压力升高及高级别膀胱输尿管反流。清洁间歇性导尿和抗胆碱能治疗未能改善尿动力学参数。鉴于上尿路持续存在风险，遂行会阴尿道造口术，以便以系列方式进行外括约肌扩张。
患者在直视下接受了2次积极的外括约肌扩张术（30F）。第二次扩张在门诊进行，未使用麻醉。随后的膀胱测压评估显示膀胱储尿功能显著改善，顺应性提高，逼尿肌漏尿点压力安全。此外，随访影像学检查显示膀胱输尿管反流完全消失。
会阴尿道造口术的创建和维持是治疗一些高危脊髓脊膜膨出症男童的一项有价值的创新。这种易于逆转的改道术允许进行积极的、序贯的外括约肌扩张，并能显著改善膀胱储尿功能。
