Departments of Urology, Boston Children's Hospital and Brigham and Women's Hospital (SK), Boston, Massachusetts.
Departments of Urology, Boston Children's Hospital and Brigham and Women's Hospital (SK), Boston, Massachusetts.
J Urol. 2014 May;191(5 Suppl):1547-52. doi: 10.1016/j.juro.2013.10.104. Epub 2014 Mar 26.
Concern in patients with bladder exstrophy after reconstruction regarding potential injury to pelvic neurourological anatomy and a resultant functional deficit prompted combined (simultaneous) cystometrography and electromyography after complete primary repair of bladder exstrophy. We determined whether complete primary repair of bladder exstrophy would adversely affect the innervation controlling bladder and external urethral sphincter function.
Complete primary repair of bladder exstrophy was performed via a modified Mitchell technique in newborns without osteotomy. Postoperative evaluation included combined cystometrography and needle electrode electromyography via the perineum, approximating the external urethral sphincter muscle complex. Electromyography was done to evaluate the external urethral sphincter response to sacral reflex stimulation and during voiding.
Nine boys and 4 girls underwent combined cystometrography/electromyography after complete primary repair of bladder exstrophy. Age at study and time after complete primary repair of bladder exstrophy was 3 months to 10 years (median 11.5 months). Cystometrography revealed absent detrusor overactivity and the presence of a sustained detrusor voiding contraction in all cases. Electromyography showed universally normal individual motor unit action potentials of biphasic pattern, amplitude and duration. The external urethral sphincter sacral reflex response was intact with a normal caliber with respect to Valsalva, Credé, bulbocavernosus and anocutaneous (bilateral) stimulation. Synergy was documented by abrupt silencing of external urethral sphincter electromyography activity during voiding.
After complete primary repair of bladder exstrophy combined cystometrography/electromyography in patients with bladder exstrophy showed normal neurourological findings, including sacral reflex responses, sustained detrusor voiding contraction and synergic voiding, in all patients postoperatively. These findings confirm the safety of complete primary repair of bladder exstrophy. Based on our results we have discontinued routine electromyography in these patients.
膀胱外翻患者在重建后对骨盆神经泌尿解剖结构潜在损伤以及由此导致的功能缺陷表示担忧，这促使我们在膀胱外翻完全一期修复后进行联合（同期）膀胱测压和肌电图检查。我们旨在确定膀胱外翻完全一期修复是否会对控制膀胱和尿道外括约肌功能的神经支配产生不利影响。
通过改良的 Mitchell 技术对新生儿进行无截骨的膀胱外翻完全一期修复。术后评估包括通过会阴进行联合膀胱测压和针电极肌电图检查，模拟尿道外括约肌复合体。肌电图用于评估尿道外括约肌对骶反射刺激和排尿时的反应。
9 名男孩和 4 名女孩在膀胱外翻完全一期修复后进行了联合膀胱测压/肌电图检查。研究时的年龄和膀胱外翻完全一期修复后的时间为 3 个月至 10 年（中位数为 11.5 个月）。膀胱测压显示所有病例均存在无逼尿肌过度活动，且存在持续的逼尿肌排尿收缩。肌电图显示所有病例的个体运动单位动作电位均为双相模式，幅度和持续时间正常。尿道外括约肌的骶反射反应完整，尿道外括约肌的正常口径与 Valsalva、Credé、球海绵体肌和肛门皮肤（双侧）刺激有关。在排尿过程中，尿道外括约肌肌电图活动突然停止，证明存在协同作用。
在膀胱外翻完全一期修复后，所有患者的联合膀胱测压/肌电图检查均显示正常的神经泌尿学发现，包括骶反射反应、持续的逼尿肌排尿收缩和协同排尿。这些发现证实了膀胱外翻完全一期修复的安全性。基于我们的结果，我们已经停止了这些患者的常规肌电图检查。
