Pitié-Salpétrière Academic Hospital, Department of Urology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France.
Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France.
Neurourol Urodyn. 2019 Jan;38(1):330-337. doi: 10.1002/nau.23857. Epub 2018 Oct 23.
To report the very long-term functional outcomes of augmentation cystoplasty (AC) in adult spina bifida patients.
All consecutive adult spina bifida patients who underwent AC between 1991 and 2008 were enrolled. Early postoperative complications (Clavien-Dindo classification) and long-term outcomes (voiding modalities, urodynamic parameters, renal function, continence, and quality of life) were assessed.
Twenty-eight patients with a median age of 20 years (IQR 17-25) were included. They all underwent AC with a supratrigonal cystectomy (SC). The median follow-up was 13.6 years (IQR 6-16.5). Thirteen early postoperative complications (12 grade I-II, 1 grade III) were observed in 11 patients (39%). Eight patients (29%) had upper urinary tract infections managed with antibiotics, with 2 patients requiring ureteral stents. Bladder stones occurred in 2 patients (7%) and were managed with endoscopy and cystostomy. One bladder perforation was reported. One bladder cancer was observed 26 years after surgery. Creatinine clearance and all urodynamic parameters were significantly improved post-operatively. The overall complication and reoperation rates were 57% and 14%, respectively. At last follow up, the continence rate was 71% (n = 20), with 93% (n = 26) performing intermittent self-catheterization. Quality of life was improved for 71% of patients.
In adult spina bifida population, AC is a high-risk procedure with an overall complication rate of 57% and a reoperation rate of 14%. However, AC is beneficial to the overall health of the patients since it provides a satisfying continence rate, an improvement of quality of life, and long-term protection of the upper urinary tract.
报告成人脊髓脊膜膨出患者接受膀胱扩大术（AC）后的非常长期的功能结果。
纳入了 1991 年至 2008 年间接受 AC 的所有连续成年脊髓脊膜膨出患者。评估了早期术后并发症（Clavien-Dindo 分级）和长期结果（排尿方式、尿动力学参数、肾功能、控尿和生活质量）。
28 例患者的中位年龄为 20 岁（IQR 17-25），均接受了超三角胱切除术（SC）的 AC。中位随访时间为 13.6 年（IQR 6-16.5）。11 例患者（39%）观察到 13 例早期术后并发症（12 例 I-II 级，1 例 III 级）。8 例（29%）患者因上尿路感染接受抗生素治疗，2 例患者需要输尿管支架。2 例患者发生膀胱结石，经内镜和膀胱造口术治疗。报告了 1 例膀胱穿孔。1 例膀胱癌发生在手术后 26 年。术后肌酐清除率和所有尿动力学参数均显著改善。总体并发症和再次手术率分别为 57%和 14%。最后一次随访时，控尿率为 71%（n=20），93%（n=26）间歇性自行导尿。71%的患者生活质量得到改善。
在成年脊髓脊膜膨出人群中，AC 是一种高风险的手术，总体并发症发生率为 57%，再次手术率为 14%。然而，AC 对患者的整体健康有益，因为它提供了令人满意的控尿率、生活质量的提高和对上尿路的长期保护。
