Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
J Urol. 2011 Sep;186(3):1041-6. doi: 10.1016/j.juro.2011.04.099. Epub 2011 Jul 23.
The reasons for referral and treatment strategies in patients who underwent complete primary repair of bladder exstrophy elsewhere in the newborn period were evaluated.
An institutionally approved database identified patients who underwent complete primary repair of exstrophy and were subsequently referred for continued care.
A total of 10 females and 55 males were referred for treatment between 1996 and 2010. Six females and 23 males were referred for complications following initial complete primary repair of exstrophy. Female complications included dehiscence (3 patients), prolapse (2) and stricture (1). Male complications included dehiscence (10 patients), prolapse (9), pubic separation (1) and stricture (3). Nine males had posterior urethral loss and 13 had major penile soft tissue injuries. Grade V vesicoureteral reflux and severe hydronephrosis were seen in the 4 patients with urethral strictures. Patients with dehiscence or prolapse underwent successful reclosure with osteotomy. Cases with posterior urethral loss or strictures were repaired with grafts. Four females and 32 males were referred for incontinence. Nine of these patients had poor bladder capacity, of whom 5 underwent bladder augmentation with continent stoma and 4 are awaiting further bladder growth. A total of 27 patients underwent bladder neck repair, with 15 (56%) subsequently continent, 5 (19%) daytime continent with nocturnal incontinence and 7 (26%) continuously incontinent. At initial closure osteotomy had been performed in all patients who were continent following bladder neck reconstruction and in 4 of 5 who were daytime continent.
Complications of complete primary repair of bladder exstrophy can result in undesired upper urinary tract changes and penile soft tissue loss. Surgical reconstruction of such complications and acceptable continence are attainable in select cases.
评估在新生儿期 elsewhere 行完全一期膀胱外翻修复术的患者转诊和治疗策略的原因。
机构批准的数据库确定了接受完全一期膀胱外翻修复术且随后转诊以接受进一步治疗的患者。
1996 年至 2010 年期间，共转诊 10 名女性和 55 名男性接受治疗。6 名女性和 23 名男性因初始完全一期膀胱外翻修复术后的并发症而转诊。女性并发症包括裂开（3 例）、脱垂（2 例）和狭窄（1 例）。男性并发症包括裂开（10 例）、脱垂（9 例）、耻骨分离（1 例）和狭窄（3 例）。9 名男性有后尿道缺失，13 名男性有严重的阴茎软组织损伤。4 名尿道狭窄患者有 5 级输尿管反流和严重肾积水。有裂开或脱垂的患者行骨切开术成功再闭合。有后尿道缺失或狭窄的病例用移植物修复。4 名女性和 32 名男性因尿失禁而转诊。这些患者中有 9 人膀胱容量不足，其中 5 人接受了带可控造口的膀胱扩大术，4 人正在等待进一步的膀胱生长。共有 27 名患者行膀胱颈修复术，其中 15 名（56%）术后控尿，5 名（19%）日间控尿伴夜间遗尿，7 名（26%）持续遗尿。在膀胱颈重建后控尿的所有患者以及日间控尿的 5 名患者中的 4 名都行了初始闭合骨切开术。
完全一期膀胱外翻修复术的并发症可导致上尿路发生不理想的变化和阴茎软组织丢失。对这些并发症进行手术重建和获得可接受的控尿是可行的。
