Kiran Pethe Sahil, Panaiyadiyan Sridhar, Singh Prabhjot, Nayak Brusabhanu, Nayyar Rishi, Seth Amlesh
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Urology. 2020 Dec;146:293-298. doi: 10.1016/j.urology.2020.09.009. Epub 2020 Sep 20.
To report our single center experience in the management of untreated adult classical bladder exstrophy.
A retrospective review of 25 adults aged ≥18 years who underwent repair of the classical bladder exstrophy from April 2000 to February 2020 was performed. Patients with prior repair and neoplastic changes in the exposed bladder mucosa were excluded. The patients and primary caretakers were actively involved in the decision-making of the surgical procedures best suited them. Work-up included upper tract evaluation and random bladder mucosal biopsy.
The mean age of presentation was 25 years. Primary schooling was completed by only 32% patients. The majority (72%) of the patients opted continent catheterizable pouch. Penn pouch was the most common pouch performed. In 3 patients, a complete primary repair was done in a single setting. In 4 patients with lack of education and difficult access to nearby health care settings, ileal conduit was performed. In all except 3 (13.1%), abdominal wall closed primarily. None of the patients required osteotomy. At a mean follow-up of 6.5 years, all patients with continent pouches were continent. One patient required revision of left ureteroneocystostomy at 20 months follow-up. All except one patient, who had complete primary repair were continent at a mean follow-up of 6 years.
Management of adult classical bladder exstrophy is challenging. The various pouches extend the surgical options. Ileal conduit may be a simple alternative to complex reconstructions in unmotivated patients with poor access to the hospital.
报告我们单中心在未治疗的成年经典膀胱外翻管理方面的经验。
对2000年4月至2020年2月期间接受经典膀胱外翻修复术的25名年龄≥18岁的成年人进行回顾性研究。排除既往有修复史及暴露膀胱黏膜有肿瘤性改变的患者。患者及其主要护理人员积极参与最适合他们的手术决策。检查包括上尿路评估和随机膀胱黏膜活检。
就诊时的平均年龄为25岁。仅有32%的患者完成了小学教育。大多数（72%）患者选择可控性贮尿囊。佩恩贮尿囊是最常施行的贮尿囊。3例患者在一次手术中完成了完全一期修复。4例因缺乏教育且难以前往附近医疗机构的患者接受了回肠膀胱术。除3例（13.1%）外，腹壁均一期缝合。无一例患者需要截骨术。平均随访6.5年时，所有使用可控性贮尿囊的患者均能自主排尿。1例患者在随访20个月时需要对左输尿管膀胱吻合术进行修复。除1例完成完全一期修复的患者外，其余患者在平均随访6年时均能自主排尿。
成年经典膀胱外翻的管理具有挑战性。各种贮尿囊扩展了手术选择。对于缺乏积极性且就医不便的患者，回肠膀胱术可能是复杂重建的一种简单替代方法。
