Division of Pediatric Urology, Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J Urol. 2011 Oct;186(4):1450-4. doi: 10.1016/j.juro.2011.05.067.
Failed initial bladder exstrophy closure may hinder the natural course of bladder growth compared to successful primary reconstruction. By measuring successive bladder capacities within the first 5 years of life, we compared the rate of bladder growth in children with failed vs successful initial closure.
We used an approved bladder exstrophy database to identify and review retrospectively patients with classic bladder exstrophy who underwent repeat cystograms between ages 1 and 6 years. Two groups of patients were identified--those with successful neonatal closure (group 1) and those with successful reclosure after an initial failed procedure (group 2). A generalized linear mixed model was fit to evaluate the impact of treatment group and age on bladder growth.
We identified 48 patients in group 1 (75% male) and 62 in group 2 (71% male). Initial pelvic osteotomy was done in 60% of group 1 and 34% of group 2. Patients in group 1 had significantly larger cystographic capacity at 2, 4, 5 and 6 years after successful bladder closure compared to those in group 2 (p <0.05). The bladder tended to grow at a significantly slower rate in group 2 (9.38 cc yearly) compared to group 1 (14.76 cc yearly, p = 0.005).
Patients with initial failed bladder exstrophy closure showed significantly smaller cystographic capacities and slower bladder growth compared to those who underwent successful neonatal bladder closure. These data clearly underscore the importance of a secure, successful primary closure.
与初次成功重建相比，初次膀胱外翻关闭失败可能会阻碍膀胱的自然生长过程。通过在生命的前 5 年内测量连续的膀胱容量，我们比较了初次关闭失败与成功的患儿的膀胱生长速度。
我们使用已批准的膀胱外翻数据库，确定并回顾性分析了在 1 至 6 岁之间接受重复膀胱造影的经典型膀胱外翻患者。确定了两组患者：一组为新生儿期成功关闭（第 1 组），另一组为初次关闭失败后再次成功关闭（第 2 组）。拟合广义线性混合模型以评估治疗组和年龄对膀胱生长的影响。
我们在第 1 组中确定了 48 例患者（75%为男性），在第 2 组中确定了 62 例患者（71%为男性）。第 1 组中有 60%的患者进行了初始骨盆截骨术，而第 2 组中有 34%的患者进行了初始骨盆截骨术。与第 2 组相比，第 1 组在初次成功膀胱关闭后的 2、4、5 和 6 年时的膀胱造影容量明显更大（p<0.05）。第 2 组的膀胱生长速度明显较慢（每年 9.38 cc），而第 1 组的膀胱生长速度较快（每年 14.76 cc，p=0.005）。
与初次成功新生儿膀胱关闭的患者相比，初次膀胱外翻关闭失败的患者的膀胱造影容量明显较小，膀胱生长速度较慢。这些数据清楚地强调了进行安全、成功的初次关闭的重要性。
