Ramalingam Manickam, Senthil Kallappan, Murugesan Anandan, Pai Mizar Ganapathy
Department of Urology, PSG Institute of Medical Sciences and Research, PSG Hospitals, 50 Avinashi Road, Peelamedu, Coimbatore 641004, India.
JSLS. 2013 Jul-Sep;17(3):450-3. doi: 10.4293/108680813X13693422522079.
In neurogenic bladder with compromised renal function or when complex reconstruction is not preferred, ileal conduit is considered. Undiversion is performed when the patient prefers the procedure, once the renal function improves, or when complications resulting from diversion are present.
We present the case of a 10-y-old boy with sacral agenesis, who underwent laparoscopic-assisted ileal conduit diversion in 2006, because he had a grossly unstable, small-capacity bladder and was not compliant with intermittent self-catheterization. At present, he preferred not to have a conduit.
Laparoscopic undiversion with ileal augmentation cystoplasty was performed. The postoperative course was uneventful, and he is now on intermittent self-catheterization with healthy renal function. Laparoscopic undiversion is technically challenging, yet feasible, and is an effective option in children. To our knowledge, this is the first such case reported.
对于肾功能受损的神经源性膀胱患者,或者当不倾向于进行复杂重建手术时,可考虑采用回肠代膀胱术。当患者倾向于该手术、肾功能改善后,或出现因改道导致的并发症时,可进行去改道术。
我们报告一例10岁患有骶骨发育不全的男孩,他在2006年接受了腹腔镜辅助回肠代膀胱术,因为他的膀胱极度不稳定且容量小,并且不配合间歇性自我导尿。目前,他不希望保留代膀胱。
进行了腹腔镜下的去改道术并加做回肠扩大膀胱成形术。术后过程顺利,他现在通过间歇性自我导尿维持肾功能正常。腹腔镜下的去改道术在技术上具有挑战性,但却是可行的,对儿童来说是一种有效的选择。据我们所知,这是首例报道的此类病例。