Pathak Piyush, Ring Joshua D, Delfino Kristin R, Dynda Danuda I, Mathews Ranjiv I
Southern Illinois University School of Medicine, Springfield, IL, USA.
Southern Illinois University School of Medicine, Springfield, IL, USA.
J Pediatr Urol. 2020 Apr;16(2):149-153. doi: 10.1016/j.jpurol.2020.01.004. Epub 2020 Jan 14.
Complete primary repair of exstrophy (CPRE) was established as a method to reduce numbers of procedures for the reconstruction of bladder exstrophy (BE). Performed since 1989, some suggest it as a replacement for the staged reconstructive procedure, the gold standard. Does CPRE reduce the numbers of procedures for reconstruction of BE?
Literature was reviewed from 1989 to 2016, and articles evaluating outcomes of patients undergoing CPRE, extracted. Effort was made to obtain final data from each reporting institution/group. Eleven articles meeting criteria were evaluated for qualitative systematic review. Age at initial closure, complications, additional procedures, and outcomes were evaluated to provide an overview of CPRE.
Ten groups reported BE management using the CPRE technique. 236 patients (153 boys; 72 girls; 11 unknown sex) had primary closure ranging from birth to 5.6 years. Osteotomy was favored by most in infants closed beyond the first 72 h of life along with spica cast immobilization. Three groups recommended concomitant augmentation for infants with small bladder capacities. Ureteral reimplantation was required in 58 patients with recurrent urinary tract infections resistant to prophylaxis. Hypospadias repair was required for most boys having complete penile disassembly, and most children eventually required bladder neck reconstruction (BNR) for continence. Overall, voiding without BNR was noted in 16-37% of children in the reported series.
Complete primary repair of exstrophy has been suggested as a single procedure for the management of BE. Literature review suggests most patients require multiple procedures to complete reconstruction and attain continence.
完全性膀胱外翻一期修复术（CPRE）被确立为一种减少膀胱外翻（BE）重建手术次数的方法。自1989年开展以来，一些人建议将其作为分期重建手术（金标准）的替代方法。CPRE是否能减少BE重建的手术次数？
回顾1989年至2016年的文献，提取评估接受CPRE治疗患者结局的文章。努力从每个报告机构/组获取最终数据。对符合标准的11篇文章进行定性系统评价。评估初次闭合时的年龄、并发症、额外手术及结局，以概述CPRE。
10个组报告了使用CPRE技术治疗BE。236例患者（153例男孩；72例女孩；11例性别未知）进行了初次闭合，年龄从出生至5.6岁。对于出生后72小时后接受闭合手术的婴儿，大多数人倾向于采用截骨术并辅以髋人字石膏固定。3个组建议对膀胱容量小的婴儿同时进行扩大手术。58例对预防性治疗耐药的复发性尿路感染患者需要进行输尿管再植术。大多数阴茎完全离断的男孩需要进行尿道下裂修复，大多数儿童最终需要进行膀胱颈重建（BNR）以实现控尿。总体而言，在所报道系列中，16% - 37%的儿童在未进行BNR的情况下能够排尿。
完全性膀胱外翻一期修复术已被提议作为BE治疗的单一手术方法。文献综述表明，大多数患者需要多次手术才能完成重建并实现控尿。
