Djordjevic Miroslav L, Vukadinovic Vojkan, Stojanovic Borko, Bizic Marta, Radojicic Zoran, Djordjevic Dejan, Krstic Zoran
School of Medicine, University of Belgrade, Belgrade, Serbia; University Children's Hospital, Belgrade, Serbia.
School of Medicine, University of Belgrade, Belgrade, Serbia; University Children's Hospital, Belgrade, Serbia.
J Urol. 2015 May;193(5 Suppl):1824-9. doi: 10.1016/j.juro.2014.11.081. Epub 2015 Mar 25.
Bladder autoaugmentation with rectus muscle backing is an efficient surgical technique for bladder augmentation. We evaluated long-term outcomes to determine the value of this procedure.
Between August 1999 and June 2004 autoaugmentation was performed in 16 girls and 7 boys 4 to 13 years old (median age 8). The indication was neurogenic bladder with small capacity and poor compliance due to myelomeningocele in 18 patients, tethered cord in 3 and sacral agenesis in 2. Detrusorectomy usually involved the whole upper half of the bladder. The prolapsed bladder urothelium was hitched to the 2 rectus muscles to prevent retraction and provide easier bladder emptying with voluntary muscle contractions.
At the median early followup of 27 months (range 9 to 49) bladder volume had increased significantly in all 23 patients (median 338 ml, range 190 to 462). At the current median long-term followup of 134 months (range 94 to 159) bladder volume continued to be significant compared to median bladder capacity preoperatively (median 419 ml, range 296 to 552). Voluntary voiding was achieved in 14 patients without post-void residual urine. Nine patients used clean intermittent catheterization, of whom only 4 could not empty the bladder voluntarily and relied only on clean intermittent catheterization.
Detrusorectomy with a rectus muscle hitch and backing is a minimally invasive, completely extraperitoneal, simple and safe procedure. However, the technique is indicated only in select cases without anterior abdominal wall anomalies.
采用腹直肌衬里的膀胱自体扩大术是一种有效的膀胱扩大手术技术。我们评估了其长期疗效以确定该手术的价值。
1999年8月至2004年6月期间，对16名女孩和7名男孩（年龄4至13岁，中位年龄8岁）实施了自体扩大术。18例患者的手术指征为因脊髓脊膜膨出导致膀胱容量小且顺应性差的神经源性膀胱，3例为脊髓栓系，2例为骶骨发育不全。逼尿肌切除术通常涉及膀胱的整个上半部分。将脱垂的膀胱尿路上皮固定于两条腹直肌，以防止回缩，并通过随意肌收缩使膀胱更容易排空。
在中位早期随访27个月（范围9至49个月）时，所有23例患者的膀胱容量均显著增加（中位值338 ml，范围190至462 ml）。在当前中位长期随访134个月（范围94至159个月）时，与术前膀胱容量中位数（中位值419 ml，范围296至552 ml）相比，膀胱容量仍然显著。14例患者实现了自主排尿且无残余尿。9例患者采用清洁间歇性导尿，其中仅4例不能自主排空膀胱，仅依靠清洁间歇性导尿。
带腹直肌固定和衬里的逼尿肌切除术是一种微创、完全腹膜外、简单且安全的手术。然而，该技术仅适用于无前腹壁异常的特定病例。
