Department of Pediatric Surgery and Urology, Auf der Bult Kinder- und Jugendkrankenhaus , Hannover , Germany ; Charité Universitätsmedizin Berlin, Virchow Klinikum , Berlin , Germany.
Department of Pediatric Surgery and Urology, Auf der Bult Kinder- und Jugendkrankenhaus , Hannover , Germany.
Front Pediatr. 2013 Oct 7;1:25. doi: 10.3389/fped.2013.00025.
Alternatives to conventional enterocystoplasty have been developed in order to avoid the most common complications derived from contact of the urine with intestinal mucosa. In this article critically we review the literature on the topics: ureterocystoplasty, detrusorectomy, detrusorotomy, seromuscular gastroenterocystoplasty, use of off the shelf biomaterials, and bladder augmentation by bioengineering. Recognizing the difficulty of deciding when a child with a history of posterior urethral valves requires and augmentation and that the development of a large megaureter in cases of neurogenic dysfunction represents a failure of initial treatment, we conclude that ureterocystoplasty can be useful in selected cases when a large dilated ureter is available. Seromuscular colocystoplasty lined with urothelium (SCLU) has been urodynamically effective in several series when the outlet resistance is high and no additional intravesical procedures are necessary. Seromuscular gastrocystoplasty lined with urothelium seems to offer no distinct advantages and involves a much more involved operation. The use of seromuscular segments without urothelial preservation, with or without the use of an intravesical balloon has been reported as successful in two centers but strict urodynamic evidence of its effectiveness is lacking. The published evidence argues strongly against the use of detrusorectomy or detrusorotomy alone because of the lack of significant urodynamic benefits. Two recent reports discourage the use of small intestinal submucosa patches because of a high failure rate. Finally, research into the development of a bioengineered bladder constructed with cell harvested from the same patient continues but is fraught with technical and conceptual problems. In conclusion of the methods reviewed, only ureterocystoplasty and SCLU have been proven urodynamically effective and reproducible.
为了避免尿液与肠黏膜接触而产生的最常见并发症，已经开发出了替代传统肠膀胱成形术的方法。本文批判性地回顾了关于以下主题的文献：输尿管膀胱成形术、膀胱切除术、膀胱切开术、黏膜下层-浆肌层胃-肠膀胱成形术、使用现成的生物材料、生物工程膀胱扩大术。鉴于很难确定曾经患有后尿道瓣膜的儿童何时需要进行扩张术，以及神经源性功能障碍导致的巨大巨输尿管的发展代表了初始治疗的失败，我们得出结论，当存在大的扩张输尿管时，输尿管膀胱成形术在某些情况下可能是有用的。在出口阻力较高且无需进行其他膀胱内手术的情况下，黏膜下层-浆肌层膀胱成形术（SCLU）在几个系列中在尿动力学上是有效的。黏膜下层-浆肌层胃-肠膀胱成形术似乎没有明显的优势，而且涉及到更复杂的手术。已经有报道称，使用没有尿路上皮保留的浆肌段，无论是否使用膀胱内球囊，在两个中心都取得了成功，但缺乏严格的尿动力学有效性证据。已发表的证据强烈反对单独使用膀胱切除术或膀胱切开术，因为缺乏明显的尿动力学益处。最近的两项报告不鼓励使用小肠黏膜下层贴片，因为失败率很高。最后，用取自同一患者的细胞构建生物工程膀胱的研究仍在继续，但存在技术和概念上的问题。综上所述，在所回顾的方法中，只有输尿管膀胱成形术和 SCLU 在尿动力学上被证明是有效且可重复的。
