Borer Joseph G, Gargollo Patricio C, Hendren W Hardy, Diamond David A, Peters Craig A, Atala Anthony, Grant Rosemary, Retik Alan B
Department of Urology and Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Urol. 2005 Oct;174(4 Pt 2):1674-8; discussion 1678-9. doi: 10.1097/01.ju.0000175942.27201.59.
Complete primary repair of bladder exstrophy (CPRE) represents a paradigm shift from the staged approach for surgical management. We present early clinical outcomes in our patients following CPRE.
From 1996 to 2004 all newborns with bladder exstrophy were treated with CPRE within 48 hours of birth. We reviewed parameters including transfusions (packed red blood cells), urethral meatal position, complications, findings on renal ultrasound and renal scan, and post-CPRE procedures and infections.
A total of 16 boys and 7 girls were treated with CPRE. Followup ranged from 8 to 96 months. Twelve boys (75%) and 2 girls (29%) received packed red blood cells at CPRE (p = 0.066). The tubularized urethral plate could not be brought to the penile tip, resulting in hypospadias in 9 of 11 boys (82%) with the running suture technique and only 1 of 5 boys (20%) with the interrupted technique (p = 0.036). Of the 23 patients 6 had a total of 8 complications after CPRE. Vesicoureteral reflux was present in 17 of 23 patients. After CPRE a total of 93 endoscopic/surgical procedures (median 4, range 0 to 16 per patient) were performed. Five patients had 1 to 4 episodes of pyelonephritis, 16 of 23 had 1 or more episodes of asymptomatic bacteriuria and 5 had cortical defects on renal scan.
We recommend that urethral closure during CPRE be performed with interrupted suture technique to prevent hypospadias. An aggressive approach should be taken toward reflux in the setting of urinary infection. Consideration should be given for repair of all aspects of the defect during CPRE, including bilateral ureteral reimplantation.
膀胱外翻一期修复术（CPRE）代表了手术治疗从分期手术方法的范式转变。我们展示了接受CPRE治疗的患者的早期临床结果。
1996年至2004年，所有膀胱外翻的新生儿在出生后48小时内接受CPRE治疗。我们回顾了包括输血（浓缩红细胞）、尿道外口位置、并发症、肾脏超声和肾扫描结果以及CPRE术后的操作和感染等参数。
共有16名男孩和7名女孩接受了CPRE治疗。随访时间为8至96个月。12名男孩（75%）和2名女孩（29%）在CPRE时接受了浓缩红细胞输血（p = 0.066）。管状尿道板无法到达阴茎顶端，采用连续缝合技术的11名男孩中有9名（82%）出现尿道下裂，而采用间断缝合技术的5名男孩中只有1名（20%）出现尿道下裂（p = 0.036）。23名患者中有6名在CPRE后共出现8种并发症。23名患者中有17名存在膀胱输尿管反流。CPRE后共进行了93次内镜/外科手术（中位数为4次，每位患者范围为0至16次）。5名患者有1至4次肾盂肾炎发作，23名患者中有16名有1次或更多次无症状菌尿发作，5名患者肾扫描有皮质缺损。
我们建议在CPRE期间采用间断缝合技术进行尿道闭合以预防尿道下裂。对于泌尿系统感染情况下的反流应采取积极的处理方法。在CPRE期间应考虑修复缺损的所有方面，包括双侧输尿管再植。
