Division of Pediatric Urology, Cairo University Pediatric Hospital, Cairo, Egypt.
J Pediatr Urol. 2009 Dec;5(6):496-9. doi: 10.1016/j.jpurol.2009.03.015. Epub 2009 May 15.
Reconstruction of bladder exstrophy remains a challenge. We evaluated our experience with complete primary repair in classic bladder exstrophy.
A retrospective data review was conducted of bladder exstrophy patients presenting at our institution between May 2000 and September 2007. Fifty-one patients (21 females and 30 males) with classic bladder exstrophy were included. Age of presentation ranged from 24h to 14 months. Mean follow up was 3 years (1 month-7 years). Patients were evaluated for continence, upper tract dilatation and cosmetic result.
Eight patients (15.6%) had failed closures and six (11.7%) had fistulae. Evaluation of continence excluded 16 patients not followed up at our center. Thirty-seven percent were continent on clean intermittent catheterization after the age of 5 years. Patients became dry only after augmentation cystoplasty. Upper tract changes were mild during our study with all patients having normal serum creatinine.
Patients may require more than one procedure for reconstruction. In our series, augmentation was required to achieve acceptable dryness. Early promising results with dry intervals in young patients did not translate to continence in older patients.
膀胱外翻的重建仍然是一个挑战。我们评估了我们在经典膀胱外翻中完全一期修复的经验。
对 2000 年 5 月至 2007 年 9 月在我院就诊的膀胱外翻患者进行了回顾性数据分析。纳入 51 例（21 名女性和 30 名男性）经典膀胱外翻患者。发病年龄为 24 小时至 14 个月。平均随访 3 年（1 个月至 7 年）。患者的尿控、上尿路扩张和美容效果进行了评估。
8 例（15.6%）患者的闭合术失败，6 例（11.7%）患者出现瘘管。在本研究中，有 16 名患者因未在本中心随访而被排除在外。37%的患者在 5 岁后能通过清洁间歇性导尿实现尿控。仅在接受膀胱扩大术后，患者才会实现完全尿控。在我们的研究中，上尿路变化较轻微，所有患者的血清肌酐均正常。
患者可能需要多次手术重建。在我们的系列中，需要进行膀胱扩大术才能达到可接受的干燥状态。在年轻患者中，早期有令人鼓舞的间歇性干燥结果，但在年长患者中并未转化为尿控。
