Liguori Riberto, Barroso Ubirajara, Matos Joao T, Ottoni Sergio L, Garrone Gilmar, Demarchi Guilherme T, Ortiz Valdemar, Macedo Antonio
Division of Urology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
Int Braz J Urol. 2006 Nov-Dec;32(6):689-94; discussion 695-6. doi: 10.1590/s1677-55382006000600010.
To evaluate the role of elective appendicovesicostomy in association with Monfort abdominoplasty to avoid urinary tract infection (UTI) and renal damage in the post-operative follow-up of patients with prune belly syndrome.
We followed 4 patients operated in our institution (UNIFESP) (Monfort, orchidopexy and Mitrofanoff) and compared them to 2 patients treated similarly, but without an appendicovesicostomy, in a second institution (UFBA). We evaluated postoperative clinical complications, UTI and preservation of renal parenchyma. Patients were followed as outpatients with urinalysis, ultrasonography (US) and occasionally with renal scintigraphy.
Mean follow-up was 23.5 months. Immediate post-operative course was uneventful. We observed that only one patient with the Mitrofanoff channel persisted with UTI, while the 2 patients used as controls persisted with recurrent pyelonephritis (> 2 UTI year).
Our data suggest that no morbidity was added by the appendicovesicostomy to immediate postoperative surgical recovery and that this procedure may have a beneficial effect in reducing postoperative UTI events and their consequences by reducing the postvoid residuals in the early abdominoplasty follow-up. However, we recognize that the series is small and only a longer follow-up with a larger number of patients will allow us to confirm our suppositions. We could not make any statistically significant assumptions regarding differences in renal preservation due to the same limitations.
评估选择性阑尾膀胱造口术联合蒙福特腹壁成形术在减少梅干腹综合征患者术后随访中尿路感染（UTI）及肾损害方面的作用。
我们对在我院（圣保罗联邦大学）接受手术（蒙福特手术、睾丸固定术和米特罗法诺夫手术）的4例患者进行随访，并与在另一机构（巴伊亚联邦大学）接受类似治疗但未行阑尾膀胱造口术的2例患者进行比较。我们评估了术后临床并发症、UTI及肾实质的保留情况。对患者进行门诊随访，检查项目包括尿液分析、超声检查（US），偶尔还进行肾闪烁显像。
平均随访时间为23.5个月。术后即刻病程平稳。我们观察到，只有1例采用米特罗法诺夫通道的患者持续存在UTI，而作为对照的2例患者持续存在复发性肾盂肾炎（每年>2次UTI）。
我们的数据表明，阑尾膀胱造口术并未增加术后即刻手术恢复的发病率，并且该手术可能通过减少早期腹壁成形术随访中的残余尿量，对减少术后UTI事件及其后果产生有益影响。然而，我们认识到该系列病例数量较少，只有对更多患者进行更长时间的随访才能证实我们的推测。由于同样的局限性，我们无法就肾保留方面的差异做出任何具有统计学意义的假设。
