Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain; Department of Pediatric Urology, La Paz Children's University Hospital, Madrid, Spain.
Department of Pediatric Surgery, La Paz Children's University Hospital, Madrid, Spain.
J Pediatr Urol. 2023 Jun;19(3):297-303. doi: 10.1016/j.jpurol.2023.01.019. Epub 2023 Feb 10.
Simultaneous performance of artificial urinary sphincter (AUS) placement and bladder augmentation (BA) in patients with neuropathic bladder is currently controversial.
The aim of this study is to describe our very long-term results after a median follow-up of 17 years.
A retrospective single-center case-control study was performed in patients with neuropathic bladder treated in our institution between 1994 and 2020, in whom AUS placement and BA were performed simultaneously (SIM group) or sequentially at different times (SEQ group). Demographic variables, hospital length of stay (LOS), long-term outcomes and postoperative complications were compared between both groups.
A total of 39 patients (21 males, 18 females) were included, with a median age of 14.3 years. BA and AUS were performed simultaneously at the same intervention in 27 patients, and sequentially in different interventions in 12 cases, with a median of 18 months between both surgeries. No demographics differences were observed. SIM group had a shorter median LOS when compared to SEQ group, considering the two sequential procedures (10 vs. 15 days; p = 0.032). Median follow-up was 17.2 years (interquartile range 10.3-23.9). Four postoperative complications were reported, 3 patients in SIM group and 1 case in SEQ group, with no statistically significant differences between them (p = 0.758). Adequate urinary continence was achieved in more than 90% of patients in both groups.
There are scarce recent studies comparing the combined performance of simultaneous or sequential AUS and BA in children with neuropathic bladder. The results of our study show a much lower postoperative infection rate than previously reported in the literature. It is a single-center analysis with a relatively small sample of patients although it is among the largest series published so far, and presents the longest long-term follow-up with more than 17 years of median follow-up time.
Simultaneous BA and AUS placement appears safe and efficacious in children with neuropathic bladder, with shorter LOS and no differences in postoperative complications or long-term outcomes when compared to performing the two procedures sequentially at different times.
同时进行人工尿道括约肌（AUS）植入和膀胱扩大术（BA）治疗神经源性膀胱目前存在争议。
本研究旨在描述我们的中位随访 17 年后的长期结果。
对 1994 年至 2020 年在我院接受治疗的神经源性膀胱患者进行回顾性单中心病例对照研究，这些患者同时（SIM 组）或不同时间（SEQ 组）先后进行 AUS 植入和 BA。比较两组患者的人口统计学变量、住院时间（LOS）、长期结果和术后并发症。
共纳入 39 例患者（21 例男性，18 例女性），中位年龄为 14.3 岁。27 例患者同时在同一次干预中进行 BA 和 AUS，12 例患者在不同干预中先后进行，两次手术的中位间隔为 18 个月。两组患者的人口统计学差异无统计学意义。与 SEQ 组相比，SIM 组的 LOS 更短，考虑到两次序贯手术（10 天 vs. 15 天；p=0.032）。中位随访时间为 17.2 年（四分位间距 10.3-23.9）。SIM 组有 3 例患者和 SEQ 组有 1 例患者发生 4 例术后并发症，两组间无统计学差异（p=0.758）。两组患者的尿控均超过 90%。
目前很少有研究比较同时或先后进行 AUS 和 BA 在神经源性膀胱患儿中的效果。我们的研究结果显示，术后感染率远低于文献报道。这是一项单中心分析，患者样本量相对较小，但这是目前发表的最大系列研究之一，具有最长的中位随访时间超过 17 年。
同时进行 BA 和 AUS 植入术在神经源性膀胱患儿中是安全有效的，与先后不同时间进行两次手术相比，其 LOS 更短，术后并发症或长期结果无差异。
