Arab Hesham O, Helmy Tamer E, Abdelhalim Ahmed, Soltan Mohamed, Dawaba Mohamed E, Hafez Ashraf T
Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Urology. 2018 Jul;117:131-136. doi: 10.1016/j.urology.2018.03.044. Epub 2018 Apr 9.
To demonstrate the long-term outcome of a contemporary series of 64 children who underwent complete primary repair of bladder exstrophy (CPRE) in a single tertiary referral center.
Between 1998 and 2012, 64 children, 47 boys and 17 girls, were identified. Only 60 of the 64 cases were available for follow-up. The follow-up was done by renal bladder ultrasound and serum creatinine every 3 months and voiding cystourethrogram from 6 to 12 months postoperatively. Continence was defined as dryness ≥3 hours.
Median (range) follow-up is 14 years (from 5 to 19 years). Voided continence was achieved in 14 children (23%) after CPRE only. Additionally, 6 children were continent after bladder neck reconstruction (BNR) and 2 after bladder neck injection (BNI), raising the percentage of voided continence to 36%. The remaining 38 (64%) patients were using clean intermittent catheterization. All cases were continent at last assessment. The results of BNR or BNI were better in de novo than in redo cases (P <.05). The percentage of cases that needed augmentation ileocystoplasty in combination with multiple bladder neck procedures was lower in both female and de novo cases (P <.05).
The percentage of children with classic bladder exstrophy who underwent CPRE who will achieve continence with volitional voiding via the urethra is 36%. The continence results after BNR and BNI are better in de novo cases than in redo ones. Continence in female and de novo cases is more likely to be achieved with lower number of continence procedures.
在单一三级转诊中心展示当代64例接受膀胱外翻完全初次修复术（CPRE）的儿童的长期预后情况。
1998年至2012年间，确定了64例儿童，其中47例男孩和17例女孩。64例中仅有60例可供随访。随访通过每3个月进行肾膀胱超声检查和血清肌酐检测，术后6至12个月进行排尿性膀胱尿道造影。控尿定义为干燥≥3小时。
中位（范围）随访时间为14年（5至19年）。仅CPRE术后，14例儿童（23%）实现了排尿控尿。此外，6例儿童在膀胱颈重建（BNR）后实现控尿，2例在膀胱颈注射（BNI）后实现控尿，使排尿控尿的百分比提高到36%。其余38例（64%）患者采用清洁间歇性导尿。在最后一次评估时，所有病例均实现控尿。BNR或BNI的结果在初次手术病例中优于再次手术病例（P <.05）。在女性和初次手术病例中，需要回肠膀胱扩大术联合多次膀胱颈手术的病例百分比更低（P <.05）。
接受CPRE的典型膀胱外翻儿童中，通过尿道自主排尿实现控尿的百分比为36%。BNR和BNI后的控尿结果在初次手术病例中优于再次手术病例。女性和初次手术病例通过较少的控尿程序更有可能实现控尿。
