Abdelhalim Ahmed, Elshal Ahmed M, Elsawy Amr A, Helmy Tamer E, Orban Hesham A, Dawaba Mohamed E, Hafez Ashraf T
Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
J Urol. 2015 Nov;194(5):1414-9. doi: 10.1016/j.juro.2015.05.028. Epub 2015 May 15.
We sought to evaluate long-term outcomes of the Bricker conduit urinary diversion in children.
We retrospectively reviewed the database of a single tertiary center for children who had undergone ileal conduit between 1981 and 2011. Patients followed for less than 1 year were excluded. Patient files were reviewed for demographics, diversion indication, preoperative imaging, surgical details, hospital readmissions and followup data. Renal function at baseline and last followup was assessed by estimated glomerular filtration rate, calculated using the modified Schwartz or MDRD (Modified Diet in Renal Disease) formula. Growth charts elucidated patient growth patterns, while an internally designed quality of life questionnaire demonstrated patient and family satisfaction with the procedure.
We evaluated 29 children who underwent Bricker conduit at a median age of 10 years (range 2 to 18) and were followed for a median of 91 months (16 to 389). Neuropathic bladder was the underlying diagnosis in 72.4% of cases. Hydronephrosis improved or remained stable in 39 of 55 studied renal units (70.9%). Although no statistically significant difference was observed between mean ± SD baseline (64.5 ± 46 ml/minute/1.73 m(2)) and last followup estimated glomerular filtration rate (54.1 ± 44.9 ml/minute/1.73 m(2)), chronic kidney disease stage had worsened in 13 patients (44.8%), end-stage kidney disease had developed in 11 patients and 9 patients had died. Six patients underwent undiversion after stabilization of renal function. Linear growth was negatively affected in 12 patients (41.4%), and 85% reported poor quality of life. A total of 19 hospital readmissions were required in 14 patients to treat diversion related complications.
The Bricker conduit does not seem to halt renal deterioration in children. Negative impact on growth and quality of life, and the anticipated rate of complications are significant limitations of the procedure in the pediatric population.
我们试图评估儿童Bricker导管尿流改道术的长期疗效。
我们回顾性分析了一家单一三级儿童中心1981年至2011年间接受回肠导管术患儿的数据库。随访时间少于1年的患者被排除。查阅患者档案，了解人口统计学资料、尿流改道指征、术前影像学检查、手术细节、再次入院情况及随访数据。通过使用改良Schwartz公式或MDRD（肾脏病改良饮食）公式计算的估计肾小球滤过率评估基线和末次随访时的肾功能。生长图表阐明患者的生长模式，而一份内部设计的生活质量问卷显示患者及其家属对该手术的满意度。
我们评估了29例接受Bricker导管术的儿童，他们的中位年龄为10岁（范围2至18岁），中位随访时间为91个月（16至389个月）。72.4%的病例潜在诊断为神经源性膀胱。在55个研究的肾单位中，39个（70.9%）肾积水得到改善或保持稳定。尽管基线时平均±标准差估计肾小球滤过率（64.5±46 ml/分钟/1.73 m²）与末次随访时（54.1±44.9 ml/分钟/1.73 m²）之间未观察到统计学显著差异，但13例患者（44.8%）的慢性肾脏病分期恶化，11例患者发展为终末期肾病，9例患者死亡。6例患者在肾功能稳定后接受了尿流改道逆转手术。12例患者（41.4%）的线性生长受到负面影响，85%的患者报告生活质量较差。14例患者因治疗尿流改道相关并发症共需19次再次入院。
Bricker导管术似乎无法阻止儿童肾功能恶化。对生长和生活质量的负面影响以及预期的并发症发生率是该手术在儿科人群中的显著局限性。
