Marte Antonio, Cavaiuolo Silvia, Esposito Maria, Pintozzi Lucia
Department of Pediatric Surgery, Second University of Naples, Naples, Italy.
Eur J Pediatr Surg. 2016 Jun;26(3):240-4. doi: 10.1055/s-0035-1551564. Epub 2015 May 19.
Introduction The objective of this study was to report on the use of vesicoscopy in the treatment of symptomatic congenital bladder diverticula (CBD) in children. Material and Methods In this study, 16 males, aged 4 to 12 years (median age, 6.25 years), were treated for symptomatic CBD; 3 patients presented double diverticulum and 13 presented single diverticulum. The presenting symptoms were recurrent urinary tract infection, hematuria, lower abdominal pain, and voiding dysfunctions as urgency, frequency alone, or in association. A first midline 5-mm trocar was introduced for a 0-degree telescope at the dome of the bladder, and two left and right 3- or 5-mm trocars were inserted through the anterolateral wall. The bladder was then insufflated with carbon dioxide to 10 to 12 mm Hg pressure. The diverticula were inverted into the bladder and the mucosa around the neck was circumcised by using scissors and hook. The defect was sutured and the bladder was drained. Vesicoureteral reflux (VUR) of third grade or higher was treated endoscopically. Results Mean operative time was 90 minutes for procedures. At 6-month follow-up, ultrasound and voiding cystourethrogram (VCUG) showed the disappearance of the diverticulum in 15 out of the 16 patients. The patient, with huge double diverticulum and fourth grade right VUR, presented recurrence of a small left diverticulum. Patients with voiding disorders presented a gradual improvement of their urgency. VUR disappeared at VCUG in all patients. Conclusion Vesicoscopic diverticulectomy resulted a safe and effective procedure and can be considered a valid alternative to the open or laparoscopic procedures. In our opinion, routine use of vesicoscopy could become the gold standard for the treatment of CBD in children.
引言 本研究的目的是报告膀胱镜检查在儿童有症状的先天性膀胱憩室（CBD）治疗中的应用。材料与方法 在本研究中，16名年龄在4至12岁（中位年龄6.25岁）的男性接受了有症状CBD的治疗；3例患者有双侧憩室，13例有单侧憩室。主要症状为反复尿路感染、血尿、下腹痛以及排尿功能障碍，如尿急、尿频或两者兼有。首先在膀胱顶部经中线插入一个5毫米的套管针用于置入0度望远镜，然后通过前外侧壁插入左右两个3毫米或5毫米的套管针。接着向膀胱内注入二氧化碳使压力达到10至12毫米汞柱。将憩室翻转至膀胱内，用剪刀和钩子环切颈部周围的黏膜。缝合缺损处并引流膀胱。对三级或更高等级的膀胱输尿管反流（VUR）进行内镜治疗。结果 手术平均时间为90分钟。在6个月的随访中，超声和排尿性膀胱尿道造影（VCUG）显示16例患者中有15例憩室消失。患有巨大双侧憩室和右侧四级VUR的患者左侧出现了一个小的憩室复发。有排尿障碍的患者尿急症状逐渐改善。所有患者的VCUG检查显示VUR消失。结论 膀胱镜下憩室切除术是一种安全有效的手术方法，可被视为开放手术或腹腔镜手术的有效替代方法。我们认为，常规使用膀胱镜检查可能会成为儿童CBD治疗的金标准。
