MacNeily Andrew E, Afshar Kourosh, Coleman Gerald U, Johnson Hjalmar W
Division of Pediatric Urology, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada.
J Urol. 2003 Oct;170(4 Pt 2):1643-6; discussion 1646. doi: 10.1097/01.ju.0000083800.25112.22.
We present our long-term results in 17 patients with myelomeningocele undergoing autoaugmentation by vesicomyotomy.
Surgery was performed from 1990 to 1994 on 17 patients with neurogenic bladder due to spinal dysraphism. Indications for autoaugmentation included upper tract deterioration and/or incontinence secondary to hypperreflexia, hypocompliance or low bladder volume. All patients had failed to respond to conservative medical and pharmacological treatments. Median patient age at surgery was 10.2 years (range 2.2 to 13.2). Outcomes were evaluated retrospectively according to changes in upper tract status, continence and urodynamic parameters. Median clinical and urodynamic followup is 75 months (range 4 to 126).
Progressive hydronephrosis developed in 5 patients, which required subsequent enterocystoplasty in 4. Of 13 patients 8 (62%) remain incontinent. Of the 17 cases 12 (71%) were considered clinical failures on the basis of upper tract deterioration and/or ongoing incontinence. There were few clinically significant improvements in urodynamic parameters, as 14 of 15 cases (93%) were considered urodynamic failures on the basis of persistent hypocompliance and/or less than expected gains in safe bladder capacity with somatic growth.
Although short-term reports of autoaugmentation have been promising, they do not appear durable. This procedure cannot be endorsed for the management of congenital neuropathic bladder.
我们报告17例脊髓脊膜膨出患者行膀胱切开自体扩大术的长期结果。
1990年至1994年对17例因脊柱裂导致神经源性膀胱的患者进行了手术。自体扩大术的指征包括上尿路恶化和/或因反射亢进、顺应性差或膀胱容量低继发的尿失禁。所有患者对保守的药物和药理学治疗均无反应。手术时患者的中位年龄为10.2岁（范围2.2至13.2岁）。根据上尿路状况、尿失禁情况和尿动力学参数的变化对结果进行回顾性评估。临床和尿动力学的中位随访时间为75个月（范围4至126个月）。
5例患者出现进行性肾积水，其中4例需要随后行肠膀胱扩大术。13例患者中有8例（62%）仍有尿失禁。17例患者中有12例（71%）因上尿路恶化和/或持续尿失禁被视为临床失败。尿动力学参数几乎没有临床上的显著改善，因为15例中有14例（93%）因持续的顺应性差和/或随着身体生长安全膀胱容量增加未达预期而被视为尿动力学失败。
尽管自体扩大术的短期报告前景良好，但结果似乎并不持久。该手术不能被认可用于先天性神经源性膀胱的治疗。
