Koyle Martin A, Butt Hissan, Lorenzo Armando, Mingin Gerald C, Elder Jack S, Smith Grahame H H
Hospital for Sick Children, Toronto, Canada.
University of Vermont, Burlington, USA.
Pediatr Surg Int. 2017 May;33(5):623-626. doi: 10.1007/s00383-017-4058-7. Epub 2017 Jan 20.
Transient urinary retention has been recognized as a complication of bilateral ureteroneocystostomy (UNC), when performed extravesically. The objective of this study was to review a collective surgeons' experiences of unilateral extra- and unilateral and/or bilateral intra-vesical ureteral reimplanation, where urinary retention greater than 6 weeks, or what we have termed, "prolonged urinary retention" (PUR), occurred.
We retrospectively reviewed charts to identify PUR after any open or robotic reimplant, other than bilateral extravesical, between 1998 and 2015 as reported by five surgeons.
During the review period, ten cases were documented where PUR was encountered. Bilateral Cohen reimplants (5), unilateral extravesical open reimplant with ureteral tapering (3), unilateral Cohen reimplant (1) and unilateral extravesical robotic reimplant with tapering (1) were associated with PUR. Younger males predominated (70%). The mean age at operation of the patients was 3.1 years. Eventually 7/10 patients were able to void normally, with periods ranging from 6 weeks to 8 years. The remaining three patients are still unable to void more than 5 years after UNC. A majority of the samples (6/10) were suspected to have bowel and bladder dysfunction (BBD), but neurologically all were normal.
PUR can occur as a potential complication following any type of UNC and is associated with the risk of significant morbidity, including permanent urinary retention. Patients and caregivers should be counseled accordingly.
膀胱外双侧输尿管膀胱吻合术（UNC）已被认为会引发短暂性尿潴留这一并发症。本研究的目的是回顾外科医生们在单侧膀胱外、单侧和/或双侧膀胱内输尿管再植术中的集体经验，这些手术出现了超过6周的尿潴留，即我们所说的“持续性尿潴留”（PUR）。
我们回顾性查阅了五名外科医生报告的1998年至2015年间除双侧膀胱外手术外的任何开放性或机器人辅助再植术后发生PUR的病例记录。
在回顾期间，记录了10例出现PUR的病例。双侧科恩再植术（5例）、单侧膀胱外开放性输尿管变细再植术（3例）、单侧科恩再植术（1例）和单侧膀胱外机器人辅助输尿管变细再植术（1例）与PUR相关。年轻男性占多数（70%）。患者的平均手术年龄为3.1岁。最终，10例患者中有7例能够正常排尿，时间从6周至8年不等。其余3例患者在UNC术后5年以上仍无法排尿。大多数样本（6/10）被怀疑存在肠道和膀胱功能障碍（BBD），但神经学检查均正常。
PUR可能是任何类型UNC术后的潜在并发症，且与包括永久性尿潴留在内的严重发病风险相关。应相应地对患者及其护理人员进行咨询。
