五岁以下儿童行可控性尿流改道术是否可行？

Is continent urinary diversion feasible in children under five years of age?

机构信息

Division of Urology, Federal University of Sao Paulo, Sao Paulo, Brazil.

出版信息

Int Braz J Urol. 2009 Jul-Aug;35(4):459-66. doi: 10.1590/s1677-55382009000400010.

DOI:10.1590/s1677-55382009000400010

PMID:19719862

Abstract

PURPOSE

To review our clinical experience with urinary continent catheterizable reservoir in children under five years of age.

MATERIALS AND METHODS

A total of 23 patients (16 males, 7 females) with a median age of 3.64 years were evaluated. Among these, 6 (26.08%) had a posterior urethral valve, 9 (39.13%) myelomeningocele, 4 (17.39%) bladder exstrophy, 2 (8.69%) genitourinary rabdomyosarcoma, 1 (4.34%) had spinal tumor and 1 (4.34%) an ano-rectal anomaly.

RESULTS

Perioperative complications were observed in four patients consisting of one febrile urinary tract infection, one partial operative wound dehiscence, one partial stomal dehiscence and one vesico-cutaneous fistula after a secondary exstrophy repair. The overall long-term complications rate was 40.90% and consisted of two stomal stenoses (9.09%), one neobladder mucosal extrusion (4.54%), three neobladder calculi (13.63%) and persistence of urinary incontinence in three patients (13.63%). The overall surgical revision was 36.36% and final continence rate was 95.45% with mean follow-up of 39.95 months

CONCLUSION

Continent urinary diversion is technically feasible even in small children, with acceptable rates of complications.

摘要

目的

回顾我们在 5 岁以下儿童中使用尿失禁可留置储尿囊的临床经验。

材料与方法

共评估了 23 例患者（男 16 例，女 7 例），平均年龄为 3.64 岁。其中，6 例（26.08%）患有后尿道瓣膜，9 例（39.13%）患有脊髓脊膜膨出，4 例（17.39%）患有膀胱外翻，2 例（8.69%）患有泌尿生殖嵴横纹肌肉瘤，1 例（4.34%）患有脊柱肿瘤，1 例（4.34%）患有肛门直肠畸形。

结果

4 例患者出现围手术期并发症，包括 1 例发热性尿路感染、1 例部分手术切口裂开、1 例部分造口裂开和 1 例二次膀胱外翻修复术后的膀胱-皮肤瘘。总体长期并发症发生率为 40.90%，包括 2 例造口狭窄（9.09%）、1 例新膀胱黏膜脱出（4.54%）、3 例新膀胱结石（13.63%）和 3 例尿失禁持续存在（13.63%）。总的手术翻修率为 36.36%，最终的控尿率为 95.45%，平均随访时间为 39.95 个月。