Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
J Pediatr Urol. 2022 Jun;18(3):355-361. doi: 10.1016/j.jpurol.2022.03.018. Epub 2022 Apr 11.
Female exstrophy-epispadias complex (BEEC) has been considered as a rare malformation of the genito-urinary tract affecting. Combining procedures during the reconstruction of bladder exstrophy-epispadias complex to reduce the number of procedures and improve the outcomes has evoked great interest.
we tried to describe the application and results of a single-stage approach for reconstruction of female BEEC during initial reconstruction or following prior failed bladder closure (FBC).
The records of 37 female patients referred for the repair of BEEC without the application of pelvic osteotomies were extracted from an institutionally approved database from September 2002 to August 2018. The mean patient age was 7.24 and 26 patients had a prior FBC. All patients underwent pelvic floor electrical stimulation and toilet training for 1 year after the closure. Complete continence was defined as having the ability to stay dry for more than 3 h without leakage during the day and night. Partial continence has traditionally been defined as retaining urine for 1-3 h or having some stress incontinence. Incontinence was defined as a continence interval of less than 1 h.
None of the patients presented bladder prolapse or dehiscence on follow-up; while stricture developed in 2 patients (5.4%). A total of 25 (67.6%) children were dry during the day and night. However, 9 (24.3%) were dry during the day but wet at night; while 3 (8.1%) were totally incontinent. The patients were followed up for a mean of 112.56 months.
Although earlier reports of this technique seem encouraging, it should be mentioned that postoperative complications are possible and difficult to manage. However, none of our patients were presented with severe postoperative complications in the follow-ups.
The single-stage technique provides satisfactory outcomes in selected patients with classic bladder exstrophy. The majority of patients attained social dryness without bladder augmentation and intermittent catheterization accompanied with minimum complication rate and best cosmetic results.
女性膀胱外翻-尿道上裂复合畸形（BEEC）被认为是一种罕见的泌尿生殖系统畸形，影响着。在重建膀胱外翻-尿道上裂复合畸形的过程中，结合手术以减少手术次数和提高疗效引起了极大的兴趣。
我们试图描述在初次重建或先前失败的膀胱闭合（FBC）后，对女性 BEEC 进行单阶段重建的应用和结果。
从 2002 年 9 月至 2018 年 8 月，从一个机构批准的数据库中提取了 37 例未行骨盆切开术的女性 BEEC 修复患者的记录。平均患者年龄为 7.24 岁，26 例患者有先前的 FBC。所有患者在闭合后进行了为期 1 年的盆底电刺激和如厕训练。完全控尿定义为白天和夜间能够保持 3 小时以上无漏尿。部分控尿传统上被定义为保留尿液 1-3 小时或有一些压力性尿失禁。失禁定义为控尿时间少于 1 小时。
随访中无患者出现膀胱脱垂或裂开；然而，有 2 例（5.4%）出现狭窄。共有 25 例（67.6%）患儿白天和夜间均保持干燥。然而，有 9 例（24.3%）仅白天干燥，夜间潮湿；而有 3 例（8.1%）完全失禁。患者的平均随访时间为 112.56 个月。
尽管该技术的早期报告似乎令人鼓舞，但应注意术后并发症是可能的，且难以处理。然而，在随访中，我们的患者均未出现严重的术后并发症。
单阶段技术为有典型膀胱外翻的选定患者提供了满意的结果。大多数患者在不进行膀胱扩大和间歇性导尿的情况下获得社交性干燥，同时并发症发生率最低，美容效果最佳。
