Mesrobian H G, Kelalis P P, Kramer S A
Department of Urology, Mayo Clinic, Rochester, Minnesota 55905.
J Urol. 1988 Apr;139(4):719-22. doi: 10.1016/s0022-5347(17)42609-7.
We reviewed 103 patients with exstrophy of the bladder. Followup was more than 15 years in 51 patients. Initial management consisted of primary bladder closure in 32 patients and urinary diversion in 71. Urinary continence, renal function, urinary tract infections and development of malignant lesions were evaluated. Factors leading to success or failure were analyzed. Although the highest continence rate (83 per cent) was achieved in 40 patients with ureterosigmoidostomy, renal functional deterioration was highest in this group, with 70 per cent of the evaluable renal units being abnormal. Furthermore, 10 per cent of this group died of renal failure and 23 per cent lost 1 kidney each. In 26 patients with an ileal conduit 69 per cent of the renal units evaluated were abnormal. Only 1 patient died of renal failure but 27 per cent lost 1 kidney each. Of 32 patients with primary bladder closure 31 had preservation of renal function. Twelve of 18 patients (67 per cent) in whom vesical neck reconstruction had been completed had total urinary continence and 3 (17 per cent) had partial continence. The incidence of significant urinary tract infections was highest in the ureterosigmoidostomy group (63 per cent) and next to the highest in the ileal conduit group (48 per cent). Malignant lesions developed in 8 patients (8 per cent).
我们回顾了103例膀胱外翻患者。51例患者的随访时间超过15年。初始治疗包括32例行一期膀胱关闭术，71例行尿流改道术。对尿失禁、肾功能、尿路感染及恶性病变的发生情况进行了评估。分析了导致成功或失败的因素。虽然40例行输尿管乙状结肠吻合术的患者尿失禁率最高（83%），但该组肾功能恶化最为严重，70%的可评估肾单位异常。此外，该组10%的患者死于肾衰竭，23%的患者各失去1个肾脏。26例行回肠膀胱术的患者中，69%的评估肾单位异常。仅1例患者死于肾衰竭，但27%的患者各失去1个肾脏。32例行一期膀胱关闭术的患者中，31例肾功能得以保留。18例行膀胱颈重建术的患者中，12例（67%）实现了完全尿失禁，3例（17%）实现了部分尿失禁。输尿管乙状结肠吻合术组严重尿路感染的发生率最高（63%），回肠膀胱术组次之（48%）。8例患者（8%）发生了恶性病变。
