Eftekharzadeh Sahar, Sabetkish Nastaran, Sabetkish Shabnam, Kajbafzadeh Abdol-Mohammad
Section of Tissue Engineering and Stem Cells Therapy, Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib's St, Keshavarz Blvd, Tehran, 14194 33151, Islamic Republic of Iran.
Int Urol Nephrol. 2017 Feb;49(2):183-189. doi: 10.1007/s11255-016-1464-z. Epub 2016 Nov 28.
The aim of this study was to evaluate the efficacy of the endoscopic injection of calcium hydroxyapatite (CaHA) into the bladder neck (BN) region of patients with urinary incontinence and bladder exstrophy-epispadias complex (BEEC).
We designed a retrospective cohort study in which we retrospectively studied medical charts of female and male patients of BEEC who had undergone CaHA or Deflux injection for continence improvement between 2009 and 2014. Sixteen incontinent patients with a mean ± SD age of 8.09 ± 3.5 years received an endoscopic submucosal injection of 5.4 ml of pure CaHA powder with autologous plasma (group A). Patients in group B (N = 21), control group, with a mean ± SD age of 7.51 ± 2.8 years received Deflux injection (5.1 ml). The mean follow-up after injection was 38 ± 5.2 and 33 ± 4.1 months in groups A and B, respectively.
No post-injection complication was detected in none of the patients during the follow-up. Eleven patients (68.75%) in group A became socially dry following 1-2 injections, the degree of incontinence was improved in 4 patients (25%), and there was no change in one patient (6.25%). However, Deflux injection resulted in complete dryness in 14 (66.66%), improvement in the degree of incontinence in 5 (23.81%) and no change in 2 patients (9.52%), leading to no significant difference in continence achievement between CaHA and Deflux groups (p = 0.9). The statistical analysis was not significantly different in terms of bladder capacity (p = 0.7) or Q max (p = 0.8).
The preliminary results of this study revealed that CaHA may be applied as an affordable bulking agent in treatment of urinary incontinence in BEEC.
本研究旨在评估内镜下向尿失禁及膀胱外翻 - 尿道上裂复合畸形（BEEC）患者的膀胱颈（BN）区域注射羟基磷灰石（CaHA）的疗效。
我们设计了一项回顾性队列研究，回顾性研究了2009年至2014年间接受CaHA或Deflux注射以改善控尿功能的BEEC男女患者的病历。16例平均年龄为8.09±3.5岁的尿失禁患者接受了内镜下黏膜下注射5.4毫升纯CaHA粉末与自体血浆（A组）。B组（N = 21）为对照组，平均年龄为7.51±2.8岁，接受Deflux注射（5.1毫升）。A组和B组注射后的平均随访时间分别为38±5.2个月和33±4.1个月。
随访期间未在任何患者中检测到注射后并发症。A组11例患者（68.75%）在1 - 2次注射后社交场合下实现干爽，4例患者（25%）尿失禁程度改善，1例患者（6.25%）无变化。然而，Deflux注射导致14例患者（66.66%）完全干爽，5例患者（23.81%）尿失禁程度改善，2例患者（9.52%）无变化，导致CaHA组和Deflux组在控尿效果上无显著差异（p = 0.9）。膀胱容量（p = 0.7）或最大尿流率（p = 0.8）方面的统计分析无显著差异。
本研究的初步结果表明，CaHA可作为一种经济实惠的填充剂用于治疗BEEC患者的尿失禁。
