Snodgrass W, Villanueva C, Gargollo P, Jacobs M
UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9142, USA.
University of Nebraska Medical Center, 988102 Nebraska Medical Center, Omaha, NE 68196-8102, USA.
J Pediatr Urol. 2014 Oct;10(5):906-10. doi: 10.1016/j.jpurol.2014.02.005. Epub 2014 Mar 13.
We report new upper tract changes in children after bladder neck (BN) surgery without augmentation for neurogenic incontinence.
Consecutive children with neurogenic sphincteric incompetency had BN surgery without augmentation. Postoperative renal sonography and fluoroscopic urodynamics were done at 6 months, 12 months, and then annually.
There were 75 patients with mean follow-up of 48 months. Of these, 17 (23%) developed new hydronephrosis (HN) or vesicoureteral reflux (VUR). All HN resolved with medical management, as did 25% of VUR cases. Persistent VUR was treated by dextranomer/hyaluronic acid injection, or re-implantation in two patients undergoing re-operative BN surgery. There was no association between these upper tract changes and end filling pressures (<40 cm vs. >40 cm) or continence status (dry vs. wet).
Upper tract changes developed in 25% of patients with neurogenic bladders after BN surgery without augmentation during a follow-up of 48 months. All new HN and most new VUR resolved with medical management or minimally invasive intervention. No patient developed upper tract changes requiring augmentation.
我们报告了膀胱颈（BN）手术后儿童上尿路出现的新变化，这些手术未进行扩大手术治疗神经源性尿失禁。
连续纳入患有神经源性括约肌功能不全的儿童，对其进行未扩大手术的BN手术。术后分别在6个月、12个月时进行肾脏超声检查和荧光透视尿动力学检查，之后每年检查一次。
共有75例患者，平均随访48个月。其中，17例（23%）出现了新的肾积水（HN）或膀胱输尿管反流（VUR）。所有肾积水经药物治疗后均缓解，25%的膀胱输尿管反流病例也是如此。持续性膀胱输尿管反流通过注射葡聚糖/透明质酸进行治疗，或对2例接受再次手术的BN手术患者进行再植术。这些上尿路变化与终末充盈压力（<40 cm与>40 cm）或控尿状态（干爽与潮湿）之间无关联。
在48个月的随访期间，25%的神经源性膀胱患者在未进行扩大手术的BN手术后出现了上尿路变化。所有新出现的肾积水和大多数新出现的膀胱输尿管反流经药物治疗或微创干预后均缓解。没有患者出现需要进行扩大手术的上尿路变化。
