Pediatric Surgical Unit, CHU Reims, American Memorial Hospital, Reims, France.
J Urol. 2010 Sep;184(3):1116-21. doi: 10.1016/j.juro.2010.05.019. Epub 2010 Jul 21.
We present the results of a new technique using a pedicled cutaneous flap for continent cystostomy.
A total of 15 boys and 8 girls (mean +/- SD age 13.4 +/- 6.4 years) underwent continent cystostomy for neurogenic bladder (20), bladder exstrophy (2) and sequelae of hypospadias (1) between 1999 and 2008. In this procedure a rectangular pedicled flap is surgically elevated from a hairless area on the abdomen. The flap is tubularized and passed through the anterior abdominal wall directly into the bladder. A submucosal detrusor incision is made to expose the bladder mucosa, and the distal part of the flap is anastomosed to the bladder mucosa in a circular manner. The tube is positioned along the incised detrusor, which is closed over. Viability of the flap, self-catheterization management and continence status are then evaluated.
Mean +/- SD followup was 4.5 +/- 3.1 years. There was 1 case of distal necrosis of the flap, which required a secondary surgery using the Mitrofanoff technique. The 22 remaining flaps were initially viable, although 2 patients were eventually lost to followup and 3 subsequently presented with false-passage incidents requiring a few days of calibration using a balloon catheter. Dryness was achieved immediately in 73% of the cases. After adding a complementary bulking agent the dryness rate reached 77%.
We present a novel approach to continent cystostomy that is safe and easy to perform. This technique is a less invasive and more efficient alternative to other commonly used approaches.
我们介绍一种使用带蒂皮瓣行可控性膀胱造口术的新技术的结果。
1999 年至 2008 年间，共有 15 名男孩和 8 名女孩（平均年龄 13.4 ± 6.4 岁）因神经源性膀胱（20 例）、膀胱外翻（2 例）和尿道下裂后遗症（1 例）接受了可控性膀胱造口术。在该手术中，从腹部无毛发区域切取一个矩形带蒂皮瓣。将皮瓣制成管状并穿过前腹壁直接进入膀胱。在膀胱黏膜上做一个黏膜下逼尿肌切口，将皮瓣的远端以环形方式与膀胱黏膜吻合。将造瘘管放置在切开的逼尿肌上，并将其关闭。然后评估皮瓣的存活情况、自我导尿管理和控尿状态。
平均随访时间为 4.5 ± 3.1 年。有 1 例皮瓣远端坏死，需要使用 Mitrofanoff 技术进行二次手术。22 个剩余的皮瓣最初是有活力的，尽管有 2 例患者最终失访，3 例患者随后出现假性通路事件，需要使用球囊导管校准几天。73%的患者立即达到干燥状态。添加补充膨胀剂后，干燥率达到 77%。
我们提出了一种安全且易于实施的可控性膀胱造口术新方法。该技术是一种对其他常用方法更具侵袭性和效率更高的替代方法。
