Department of Urology and Pediatric Urology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Department of Urology, Maasstad Hospital, Rotterdam, the Netherlands.
J Pediatr Urol. 2019 Feb;15(1):35.e1-35.e8. doi: 10.1016/j.jpurol.2018.08.018. Epub 2018 Sep 1.
Achieving continence in children with neurogenic sphincteric incompetence is a challenge. Awareness of the long-term outcome in this young patient population is important. In the past 25 years, the study institution has built experience in bladder outlet procedures such as bladder neck sling and bladder neck reconstructions.
The objective of this study was to evaluate the long-term outcome on continence and re-intervention rate of bladder outlet procedures in children with neurogenic urinary incontinence at the study institution.
All children who underwent a bladder neck procedure between 1992 and 2017 at the study institution were retrospectively reviewed. Continence at the end of follow-up was the primary endpoint, defined as 'dry' when there was an interval of a minimum of 4 h without urinary leakage. Non-parametric tests were used for statistical analysis.
During this 25-year period, a total of 60 children underwent a bladder outlet procedure, either a bladder neck sling (n = 43) or a bladder neck reconstruction (n = 17). The median age at surgery was 11.6 years (interquartile range [IQR] 7.8-13.9). Concomitant surgery consisted of bladder augmentation in 80% and continent catheterizable urinary channel in 97% of children. Dry rate within 1 year was 38%. After a median follow-up of 10.4 years (IQR 6.5-15.5), 77% of all children were dry. Twenty-five children (42%) needed one or more re-interventions, including redo of the bladder outlet procedure, other type of outlet procedure, bulking agents, bladder augmentation, and bladder neck closure.
This study confirms that achieving continence is a challenge. The inconsistent use of the definition of urinary continence creates confusion in the literature and makes comparison of outcome with other studies difficult. Openness of (long-term) results in achieving urinary continence is important and helpful for future patients.
On the long term, the majority of children with neurogenic urinary incontinence were dry after a bladder outlet procedure, but a considerable number of patients had a re-intervention. The initial outcome on continence was slightly disappointing. Reporting long-term results is essential and helpful for patient counseling.
对于患有神经源性括约肌功能不全的儿童，实现控尿是一项挑战。了解该年轻患者群体的长期预后非常重要。在过去的 25 年中，研究机构在膀胱出口手术方面积累了经验，例如膀胱颈吊带和膀胱颈重建。
本研究旨在评估研究机构中神经源性尿失禁儿童接受膀胱出口手术后的长期控尿和再干预率。
回顾性分析 1992 年至 2017 年期间在研究机构接受膀胱颈手术的所有儿童。随访结束时的控尿是主要终点，定义为“干燥”，即至少 4 小时无尿漏间隔。使用非参数检验进行统计学分析。
在这 25 年期间，共有 60 名儿童接受了膀胱出口手术，其中 43 名接受了膀胱颈吊带术，17 名接受了膀胱颈重建术。手术时的中位年龄为 11.6 岁（四分位距 [IQR] 7.8-13.9）。80%的儿童同时行膀胱扩大术，97%的儿童行可控性尿流通道术。术后 1 年内干燥率为 38%。中位随访 10.4 年后（IQR 6.5-15.5），77%的儿童完全控尿。25 名儿童（42%）需要进行一次或多次再干预，包括膀胱出口手术的再次手术、其他类型的出口手术、膀胱内填充物、膀胱扩大术和膀胱颈闭合术。
本研究证实，实现控尿是一项挑战。文献中对尿控定义的不一致使用造成了混乱，使与其他研究的结果比较变得困难。公开实现尿控的（长期）结果对于未来的患者非常重要和有帮助。
从长远来看，大多数神经源性尿失禁儿童在接受膀胱出口手术后可以控制排尿，但相当一部分患者需要再次干预。最初的控尿结果有点令人失望。报告长期结果对于患者咨询非常重要和有帮助。
