Jayman John, Tourchi Ali, Shabaninia Mahsa, Maruf Mahir, DiCarlo Heather, Gearhart John P
James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD.
James Buchanan Brady Urological Institute, Division of Pediatric Urology, Charlotte Bloomberg Children's Hospital, The Johns Hopkins University School of Medicine, Baltimore, MD.
Urology. 2017 Nov;109:171-174. doi: 10.1016/j.urology.2017.06.023. Epub 2017 Jun 23.
To investigate the surgical course for treating bladder polyps in patients with exstrophy epispadias complex (EEC). EEC bladder polyps are unique pathologic entities, with a distinct difference between polyps discovered at birth and polyps developed after failed exstrophy closure.
A prospectively maintained database of 1300 patients with EEC was reviewed for bladder exstrophy patients with bladder polyps. The following data were obtained: patient demographics, polyp type, past medical and surgical history, and continence outcomes. Polyps were categorized as (1) primary, bladder polyps at birth or during neonatal period; and (2) secondary, bladder polyps following a failed exstrophy closure.
Of 1300 EEC patients, 43 patients with polyps met the inclusion criteria. All closures for primary polyp patients were successful, and continence outcomes remained similar in early and delayed closures (P = .689). Secondary polyp patients were more likely to require augmentation to increase bladder capacity (P = .033). Bladder neck reconstruction (n = 8) was successful in 83.0% of patients with primary polyps, and none were successful for those with secondary polyps (P = .035).
Delaying primary bladder closure for patients with small polypoid bladder templates did not affect closure or continence outcomes. However, primary and secondary polyps may require different surgical interventions. Bladder neck reconstruction was markedly less successful in secondary polyp patients, and secondary polyp patients were more likely to need augmentation to increase bladder capacity. This study emphasizes the importance of a successful primary closure and suggests that secondary polyps are an indicator of decreasing potential for bladder growth.
探讨治疗膀胱外翻-尿道上裂复合畸形（EEC）患者膀胱息肉的手术过程。EEC膀胱息肉是独特的病理实体，出生时发现的息肉与膀胱外翻修复失败后出现的息肉有明显差异。
回顾前瞻性维护的1300例EEC患者数据库，以查找患有膀胱息肉的膀胱外翻患者。获取以下数据：患者人口统计学资料、息肉类型、既往病史和手术史以及控尿结果。息肉分为：（1）原发性，出生时或新生儿期的膀胱息肉；（2）继发性，膀胱外翻修复失败后的膀胱息肉。
在1300例EEC患者中，43例有息肉的患者符合纳入标准。所有原发性息肉患者的修复均成功，早期和延迟修复的控尿结果相似（P = 0.689）。继发性息肉患者更有可能需要进行膀胱扩大术以增加膀胱容量（P = 0.033）。膀胱颈重建（n = 8）在83.0%的原发性息肉患者中成功，而继发性息肉患者无一成功（P = 0.035）。
对于膀胱息肉样小膀胱模板的患者延迟一期膀胱关闭不影响修复或控尿结果。然而，原发性和继发性息肉可能需要不同的手术干预。继发性息肉患者的膀胱颈重建明显不太成功，继发性息肉患者更有可能需要进行膀胱扩大术以增加膀胱容量。本研究强调了成功一期关闭的重要性，并表明继发性息肉是膀胱生长潜力下降的一个指标。
