Belman A B, Kaplan G W
Department of Urology, Children's Hospital National Medical Center, Washington, D.C. 20010.
J Urol. 1989 May;141(5):1160-2. doi: 10.1016/s0022-5347(17)41200-6.
The experience of 2 surgeons working independently at separate institutions is reported to demonstrate the use of the Kropp urethral lengthening and implantation procedure. This experience includes 18 patients between 6 and 19 years old (median age 11.6 years) with neurogenic bladder dysfunction. The etiology of the neuropathic bladder was myelodysplasia in 16 patients and sacral agenesis in 2. There were 10 boys and 8 girls. All patients had failed trials of clean intermittent catheterization with adjunctive pharmacological manipulation. Incontinence was a significant social problem. Of the 18 patients 2 had undergone prior urinary diversion and the Kropp procedure was used as part of undiversion. One patient had had 2 previous failed attempts at continence using an artificial urinary sphincter. Augmentation cystoplasty was an adjunctive maneuver in 14 patients; ileum was used in 8, sigmoid in 4 and the ileocecum in 2 (both of whom had been diverted previously). The bladder capacity in the 4 patients in whom augmentation was not performed ranged from 200 to 450 ml. Of the 18 patients 17 achieved a good result and 14 were considered to have achieved an excellent result. The 1 failure is the patient who previously had failed to gain control with an artificial sphincter. Of the 4 patients who did not undergo bladder augmentation 3 required adjunctive anticholinergics to achieve continence.
据报道，两位分别在不同机构独立工作的外科医生的经验展示了克罗普尿道延长及植入手术的应用。该经验涵盖了18名年龄在6至19岁（中位年龄11.6岁）的神经源性膀胱功能障碍患者。神经病变性膀胱的病因在16名患者中为脊髓发育异常，2名患者为骶骨发育不全。其中有10名男孩和8名女孩。所有患者在尝试清洁间歇性导尿并辅以药物治疗均失败。尿失禁是一个严重的社会问题。18名患者中有2名曾接受过尿流改道，克罗普手术被用作恢复尿流的一部分。1名患者此前使用人工尿道括约肌进行控尿的两次尝试均失败。14名患者采用了膀胱扩大术作为辅助手段；8名患者使用回肠，4名患者使用乙状结肠，2名患者使用回盲部（这两名患者此前均已接受尿流改道）。未进行膀胱扩大术的4名患者的膀胱容量在200至450毫升之间。18名患者中有17名取得了良好效果，14名被认为取得了优异效果。唯一失败的是此前使用人工括约肌未能实现控尿的患者。在未进行膀胱扩大术的4名患者中，3名需要辅助使用抗胆碱能药物来实现控尿。
