Hojjat Asal, Kajbafzadeh Abdol-Mohammad, Sina Alireza, Mazaheri Tina, Rad Mona Vahidi, Nezami Behtash Ghazi, Mohammadinejad Payam
Department of Urology, Pediatric Urology Research Center, Children's Hospital Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No.62, Dr. Gharib's Street, Keshavarz Boulevard, 1419733151, Tehran, Iran.
Int Urol Nephrol. 2015 Jan;47(1):11-7. doi: 10.1007/s11255-014-0865-0. Epub 2014 Nov 6.
To present a new approach for management of cutaneous vesicostomy (CV) prolapse, with special emphasis on normal appearing vesicostomy may be malfunctioning. To introduce the application of temporary stoma-free drainage as a diagnostic and therapeutic tool.
From December 2000 to September 2006, 66 children (61 males and 5 females) with CV were studied. The mean age at vesicostomy was 7 months (range 1-30), and the main underlying disease was posterior urethral valves (in 45 children, 68%). Indications for CV included significant hydroureteronephrosis (HUN) and recurrent urinary tract infection. Patients were followed up for complications and were treated based on our institutional approach. All patients with persistent upper tract dilatation and micturition per urethra underwent temporary bladder (via stoma) free drainage. Patients with stomal stenosis were managed either by a revision surgery or by simple dilatation and intermittent catheterization. Purse string suturing was applied in mucosal prolapses as the first choice.
The complications were observed in 21 patients (31%), including twelve stomal stenosis, nine severe mucosal prolapses, and two recurrent urinary infections. HUN and significant voiding per urethra persisted following initial CV in 19 out of 66 patients (29%), eleven of which having normal appearing CVs. Seventeen of these patients were managed by temporary stoma-free drainage (accompanied by purse string suturing in mucosal prolapse), and two patients with severe stenosis underwent surgical revision. Temporary stoma-free drainage improved HUN in 94% of patients (16 of 17).
Voiding per urethra is an indicator of CV malfunction, and temporary stoma-free drainage can be a diagnostic and therapeutic option in such children. A seemingly open CV may still be malfunctioning, and ureterovesical or intravesical obstructions should be considered if HUN does not improve following temporary stoma-free drainage.
介绍一种治疗皮肤造瘘口（CV）脱垂的新方法，特别强调外观正常的造瘘口可能存在功能障碍的情况。介绍临时无造瘘口引流作为一种诊断和治疗工具的应用。
对2000年12月至2006年9月期间66例患有CV的儿童（61例男性，5例女性）进行研究。造瘘口时的平均年龄为7个月（范围1 - 30个月），主要潜在疾病是后尿道瓣膜（45例儿童，占68%）。CV的适应证包括显著的肾盂输尿管积水（HUN）和反复尿路感染。对患者进行并发症随访，并根据我们机构的方法进行治疗。所有持续存在上尿路扩张且经尿道排尿的患者均接受临时膀胱（经造瘘口）无引流治疗。造瘘口狭窄的患者通过修复手术或单纯扩张及间歇性导尿进行处理。黏膜脱垂时首选荷包缝合。
21例患者（31%）出现并发症，包括12例造瘘口狭窄、9例严重黏膜脱垂和2例反复尿路感染。66例患者中有19例（29%）在初次CV术后仍存在HUN且经尿道排尿显著，其中11例造瘘口外观正常。这些患者中有17例接受了临时无造瘘口引流（黏膜脱垂时伴有荷包缝合），2例严重狭窄患者接受了手术修复。临时无造瘘口引流使94%（17例中的16例）的患者HUN得到改善。
经尿道排尿是CV功能障碍的一个指标，临时无造瘘口引流可作为此类儿童的一种诊断和治疗选择。看似开放的CV仍可能存在功能障碍，如果临时无造瘘口引流后HUN未改善，应考虑输尿管膀胱或膀胱内梗阻。
