van Geen Frank-Jan, Nieuwhof-Leppink Anka J, Schappin Renske, Klijn Aart J, de Kort Laetitia M O
Department of Urology, UMC Utrecht, the Netherlands.
Department of Medical Psychology and Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
J Pediatr Urol. 2021 Dec;17(6):791.e1-791.e5. doi: 10.1016/j.jpurol.2021.08.022. Epub 2021 Sep 3.
Girls with an anterior deflected urinary stream (ADUS) are known to wet the toilet rim and their buttocks while voiding. This deviation may prevent adopting an ideal toileting position and can thus develop into a functional voiding disorder. Although surgical correction of the urinary stream by a meatotomy is part of standard care in girls with ADUS and lower urinary tract symptoms (LUTS) at our center, little is known about the effect of this procedure on daytime urinary incontinence (DUI).
To assess the effect of meatal correction on incontinence in girls with ADUS and DUI, and to find predictors for therapy success.
A retrospective chart study including all girls with ADUS and DUI who underwent a dorsally directed meatal correction at our tertiary referral center between 2005 and 2018 (n = 274). The main outcome measurement was continence according to the International Children's Continence Society criteria, expressed as the percentage of children that were continent at post-surgical follow-up (complete response). Multivariate logistic regression was used to identify predictors of continence.
In 93% of girls, the direction of the urinary stream was no longer anterior deflected. 29% (n=79) of all girls were continent at post-surgical follow-up. We could not find a convincing predicting factor for achieving continence.
Although meatal correction is successful on normalizing the direction of the urinary stream, less than one-third of girls became continent. In addition, we were unable to indicate which girls will profit from this procedure in terms of continence. Since not every girl with ADUS develops incontinence complaints, it may also be questionable whether ADUS and incontinence are directly related. Since other, less invasive and more effective treatment options for DUI are available, meatal correction should therefore be considered a last-resort option in the treatment of pediatric DUI in girls with ADUS.
Of the 274 girls with ADUS and DUI, 29% did benefit from a meatotomy. No convincing indicator for therapy success could however be found. Therefore, we discourage a meatotomy as standard treatment in girls with ADUS and DUI.
已知患有前向性尿流偏斜（ADUS）的女孩在排尿时会弄湿马桶边缘和臀部。这种偏斜可能会妨碍采取理想的排尿姿势，进而发展为功能性排尿障碍。尽管在我们中心，通过尿道口切开术对尿流进行手术矫正，是患有ADUS和下尿路症状（LUTS）女孩标准治疗的一部分，但对于该手术对日间尿失禁（DUI）的影响知之甚少。
评估尿道口矫正对患有ADUS和DUI女孩尿失禁的影响，并找出治疗成功的预测因素。
一项回顾性图表研究，纳入了2005年至2018年间在我们的三级转诊中心接受背侧尿道口矫正术的所有患有ADUS和DUI的女孩（n = 274）。主要结局指标是根据国际儿童尿失禁协会标准判断的尿失禁情况，以术后随访时实现尿失禁的儿童百分比（完全缓解）表示。采用多因素逻辑回归来确定尿失禁的预测因素。
93%的女孩尿流方向不再向前偏斜。所有女孩中29%（n = 79）在术后随访时实现了尿失禁。我们未能找到实现尿失禁的令人信服的预测因素。
尽管尿道口矫正术成功使尿流方向正常化，但不到三分之一的女孩实现了尿失禁。此外，我们无法指出哪些女孩在尿失禁方面将从该手术中获益。由于并非每个患有ADUS的女孩都会出现尿失禁症状，ADUS与尿失禁是否直接相关也可能存在疑问。由于有其他侵入性较小且更有效的DUI治疗选择，因此在患有ADUS的女孩中，尿道口矫正术应被视为小儿DUI治疗的最后手段。
在274名患有ADUS和DUI的女孩中，29%确实从尿道口切开术中获益。然而，未找到治疗成功的令人信服的指标。因此，我们不鼓励将尿道口切开术作为患有ADUS和DUI女孩的标准治疗方法。
