膀胱外翻修复术后的长期功能结局：一个小容量单中心的经验。
Long-term functional outcomes after bladder exstrophy repair: A single, low-volume centre experience.
作者信息
Alsowayan Ossamah, Capolicchio John Paul, Jednak Roman, El-Sherbiny Mohamed
机构信息
Department of Pediatric Surgery, Division of Pediatric Urology, Montreal Children's Hospital and McGill University Health Centre, Montreal, QC, Canada;; Department of Urology, College of Medicine and King Fahd Hospital of the University, University of Dammam, Kingdom of Saudi Arabia.
Department of Pediatric Surgery, Division of Pediatric Urology, Montreal Children's Hospital and McGill University Health Centre, Montreal, QC, Canada;
出版信息
Can Urol Assoc J. 2016 Mar-Apr;10(3-4):E94-8. doi: 10.5489/cuaj.3104.
INTRODUCTION
In this study, we present our experience managing bladder exstrophy (BE) in a low-volume centre over 24 years.
METHODS
Charts of patients with BE between 1990 and 2014 were retrospectively reviewed. Patients with BE closure and ≥5 years followup were included. BE closure was carried out in the first two days of life using either complete primary repair (CPRE) or modern-staged repair (MSRE). Daytime urinary continence (UC) was evaluated by the age of five years. Patients were considered continent if completely dry for ≥3 hours using no or one pad/day. Incontinent patients with bladder capacity (BC) ≥100 ml underwent bladder neck reconstruction (BNR) and bilateral ureteric reimplantation (BUR), while patients with BC <100ml underwent simultaneous augmentation cystoplasty (ACP).
RESULTS
Sixteen (16) patients met our inclusion criteria with a mean followup time of 18±5 years. Ten (10) underwent CPRE, while six underwent MSRE. Four surgeons were involved in patients' management. Two surgeons had previous experience in BE surgery while working in other institutions. Complications included dehiscence in five patients, vesicocutanous fistula in three and breakthrough UTI in eight. Continence was achieved in 15/16 patients: two after BE closure only, seven with BNR, and six who required ACP and BNR.
CONCLUSIONS
Despite the small number of patients and the reterospective nature of the study, some observations are noteworthy. Although continence rate post-primary BE closure was initially low, it rose to 93.8% after auxiliary continence procedures. This might be at the cost of urethral voiding, which was achieved in 60% of patients. Our small cohort did not show clear advantage of CPRE vs. MSRE. Our outcomes may not be different from high-volume centres due to the fact that two exstrophy-experienced surgeons performed most primary or subsequent surgeries. For this reason, we recommend assigning designated centres for BE repair for both new and repeat cases.
引言
在本研究中，我们介绍了我们在一个小容量中心24年来管理膀胱外翻（BE）的经验。
方法
对1990年至2014年间膀胱外翻患者的病历进行回顾性分析。纳入膀胱外翻修复且随访≥5年的患者。在出生后的前两天采用完全一期修复（CPRE）或现代分期修复（MSRE）进行膀胱外翻修复。五岁时评估日间尿失禁（UC）情况。如果每天使用不超过一片尿垫且完全干爽≥3小时，则认为患者为尿失禁。膀胱容量（BC）≥100ml的尿失禁患者接受膀胱颈重建（BNR）和双侧输尿管再植术（BUR），而BC<100ml的患者则同时进行膀胱扩大成形术（ACP）。
结果
16例患者符合我们的纳入标准，平均随访时间为18±5年。10例接受CPRE，6例接受MSRE。4名外科医生参与了患者的管理。两名外科医生在其他机构工作时曾有膀胱外翻手术经验。并发症包括5例伤口裂开、3例膀胱皮肤瘘和8例突破性尿路感染。16例患者中有15例实现了尿失禁：2例仅在膀胱外翻修复后实现，7例通过BNR实现，6例需要ACP和BNR。
结论
尽管患者数量较少且研究具有回顾性，但一些观察结果值得注意。尽管一期膀胱外翻修复后的尿失禁率最初较低，但在辅助尿失禁手术后升至93.8%。这可能是以尿道排尿为代价的，60%的患者实现了尿道排尿。我们的小样本队列未显示CPRE与MSRE的明显优势。由于两名有膀胱外翻手术经验的外科医生进行了大多数一期或后续手术，我们的结果可能与大容量中心并无差异。因此，我们建议为新病例和复发病例指定专门的膀胱外翻修复中心。
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