Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
J Urol. 2011 Jun;185(6 Suppl):2563-71. doi: 10.1016/j.juro.2011.01.024. Epub 2011 Apr 28.
A major goal of bladder exstrophy management is urinary continence, often using bladder neck reconstruction. We report our experience with bladder neck reconstruction after complete primary repair of exstrophy.
Patient history, ultrasound, voiding cystourethrogram, examination using anesthesia and urodynamics were performed during a prospective evaluation. Continence was assessed using the International Children's Continence Society classification and the dry interval. Bladder capacity was measured by examination using anesthesia, voiding cystourethrogram and/or urodynamics. Urodynamics were also done to assess bladder compliance and detrusor muscle function.
From 1994 to 2010 we treated 31 male and 15 female patients with bladder exstrophy after complete primary repair of exstrophy. Of patients 5 years old or older bladder neck reconstruction was performed after complete primary repair in 9 of 21 males (43%) and in 3 of 11 females (27%) at a mean age of 6.3 and 8.1 years, respectively. By the International Children's Continence Society classification 6 of 12 patients (50%) were continent less than 1.5 years after bladder neck reconstruction and 2 of 9 (23%) were evaluable 1.5 years or greater after reconstruction. Median bladder capacity was 100 ml before, 50 ml less than 1.5 years after and 123 ml 1.5 years or greater after bladder neck reconstruction. Three males and 2 females emptied via an appendicovesicostomy. Two boys underwent augmentation.
In our experience most patients with bladder exstrophy require bladder neck reconstruction after complete primary repair of exstrophy. The need for reconstruction is more common in males. Our rates of bladder neck reconstruction after complete primary repair of exstrophy and of continence after bladder neck reconstruction are similar to those in other reports.
膀胱外翻治疗的主要目标是尿控，通常采用膀胱颈部重建。我们报告完全一期修复后行膀胱颈部重建的经验。
通过前瞻性评估，对患者进行病史、超声、排尿性膀胱尿道造影、麻醉下检查和尿动力学检查。使用国际儿童尿控协会（ICCS）分类和干燥间隔来评估尿控。通过麻醉下检查、排尿性膀胱尿道造影和/或尿动力学来测量膀胱容量。还进行尿动力学检查以评估膀胱顺应性和逼尿肌功能。
1994 年至 2010 年，我们对 31 例男性和 15 例女性膀胱外翻患者进行了完全一期修复，其中 9 例男性（43%）和 3 例女性（27%）在完全一期修复后年龄达到 5 岁或以上时行膀胱颈部重建，年龄分别为 6.3 岁和 8.1 岁。根据 ICCS 分类，12 例患者中有 6 例（50%）在膀胱颈部重建后 1.5 年内失禁，9 例中有 2 例（23%）在重建后 1.5 年或更长时间内可评估。膀胱容量在重建前为 100ml，重建后 1.5 年内减少 50ml，1.5 年后增加至 123ml。3 例男性和 2 例女性通过阑尾膀胱造口术排空。2 例男孩接受了膀胱扩大术。
在我们的经验中，大多数完全一期修复后的膀胱外翻患者需要进行膀胱颈部重建。重建的需求在男性中更为常见。我们完全一期修复后行膀胱颈部重建的比例以及膀胱颈部重建后尿控的比例与其他报道相似。
