Division of Pediatric Urology, The Johns Hopkins Hospital, Baltimore, Maryland; Urology Department, Children's Hospital of Michigan, Detroit, Michigan.
J Urol. 2013 Oct;190(4 Suppl):1583-8. doi: 10.1016/j.juro.2013.01.093. Epub 2013 Feb 1.
Complete female epispadias, which occurs much more rarely than classic bladder exstrophy in females, is thought to have a more benign clinical course. We hypothesized that patients with complete female epispadias are more likely to have a larger bladder capacity and achieve voiding continence than females with classic bladder exstrophy.
After obtaining institutional review board approval, females with complete female epispadias or classic bladder exstrophy were identified from an institutionally approved prospective database. We retrospectively reviewed the charts of 22 patients with complete female epispadias and 23 with female classic bladder exstrophy, including 3 with delayed primary closure.
Patients with complete female epispadias presented later and underwent the first reconstructive procedure at an older age than patients with classic bladder exstrophy. Patients with complete female epispadias had lower initial and final age adjusted bladder capacity than those with classic bladder exstrophy but the bladder growth rate did not differ between the groups. When patients with complete female epispadias were stratified by age at initial reconstruction, there was no difference in final age adjusted bladder capacity or the bladder growth rate. There was also no statistical difference between the groups in the number of surgeries, continence rate from initial reconstruction, bladder neck reconstruction success or need for a continent stoma.
This study suggests that females with classic bladder exstrophy who undergo successful primary closure have higher initial and final age adjusted bladder capacity than females with complete female epispadias but with a similar growth rate. This may reflect the creation of outlet resistance at a younger age than in those with complete female epispadias. However, no difference was identified between patients with complete female epispadias who initially underwent repair before vs after age 1 year. Patients with complete female epispadias undergo procedures to achieve continence that are similar to those in patients with classic bladder exstrophy.
完全型女性尿道下裂比经典型女性膀胱外翻少见得多，据认为其临床病程更良性。我们假设完全型女性尿道下裂患者的膀胱容量更大，且比经典型膀胱外翻女性更有可能实现排尿自控。
在获得机构审查委员会批准后，从机构批准的前瞻性数据库中确定了完全型女性尿道下裂和经典型女性膀胱外翻的女性患者。我们回顾性分析了 22 例完全型女性尿道下裂和 23 例经典型女性膀胱外翻患者（包括 3 例延迟性一期修复）的病历。
完全型女性尿道下裂患者的首次重建手术时间较晚，且首次重建手术年龄也大于经典型膀胱外翻患者。完全型女性尿道下裂患者的初始和最终年龄调整后膀胱容量均低于经典型膀胱外翻患者，但两组之间的膀胱生长速度没有差异。当根据初次重建的年龄对完全型女性尿道下裂患者进行分层时，最终年龄调整后膀胱容量或膀胱生长速度没有差异。两组患者在手术次数、初始重建时的控尿率、膀胱颈重建成功率或是否需要造口控尿之间也没有统计学差异。
本研究表明，成功进行一期修复的经典型膀胱外翻女性患者的初始和最终年龄调整后膀胱容量均高于完全型女性尿道下裂患者，但生长速度相似。这可能反映出在更年轻的年龄时就建立了出口阻力。然而，在 1 岁之前或之后进行初次修复的完全型女性尿道下裂患者之间没有差异。完全型女性尿道下裂患者为实现控尿而进行的手术与经典型膀胱外翻患者相似。
