Gobet Rita, Weber Daniel, Renzulli Pietro, Kellenberger Christian
Division of Urology, University Children's Hospital Zurich, Steinwiestr. 75, 8032 Zurich, Switzerland.
J Pediatr Urol. 2009 Jun;5(3):190-6. doi: 10.1016/j.jpurol.2008.11.007. Epub 2009 Jan 10.
To describe the urological and nephrological long-term outcome of patients born with classical bladder exstrophy treated with bilateral ureterosigmoidostomies in early childhood.
Out of 42 patients born with bladder exstrophy in Switzerland between 1937 and 1968, 25 participated in this study; seven had died, seven were lost to follow up and three refused consent. Assessment included chart review, clinical examination, and assessment of renal function and morphology.
After a follow-up period of 37-69 years ((mean 50 years), 13 of the 25 participants (52%) had their ureterosigmoidostomy still in place. All others had different forms of urinary diversions. Fifteen (60%) patients had normal renal function or mild chronic kidney disease as assessed by estimated glomerular filtration rate. Three patients were on renal replacement therapy. MRI (n=16) showed 10 morphologically normal kidneys. One patient suffered from adenocarcinoma of the colon, five had benign colonic polyps, one urethral papillary carcinoma and 18 no evidence of tumor.
The majority of our patients have normal or mildly impaired renal function and a well functioning ureterosigmoidostomy. This is remarkable, given the fact that ureterosigmoidostomies are considered to be refluxing high-pressure reservoirs at risk of renal injury and malignancy.
描述在幼儿期接受双侧输尿管乙状结肠吻合术治疗的经典膀胱外翻患儿的泌尿外科和肾脏病学长期预后。
1937年至1968年间在瑞士出生的42例膀胱外翻患儿中，25例参与了本研究；7例死亡，7例失访，3例拒绝同意。评估包括病历审查、临床检查以及肾功能和形态学评估。
在37至69年（平均50年）的随访期后，25例参与者中有13例（52%）的输尿管乙状结肠吻合术仍保留。所有其他患者有不同形式的尿流改道。根据估计的肾小球滤过率评估，15例（60%）患者肾功能正常或患有轻度慢性肾脏病。3例患者接受肾脏替代治疗。MRI（n = 16）显示10个肾脏形态正常。1例患者患有结肠癌，5例有良性结肠息肉，1例有尿道乳头状癌，18例无肿瘤证据。
我们的大多数患者肾功能正常或轻度受损，输尿管乙状结肠吻合术功能良好。考虑到输尿管乙状结肠吻合术被认为是有肾损伤和恶性肿瘤风险的反流性高压贮尿器，这一结果很显著。
