Division of Urology, Cleveland Clinic Children's, USA.
Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Pediatr Urol. 2023 Oct;19(5):565.e1-565.e5. doi: 10.1016/j.jpurol.2023.05.016. Epub 2023 Jun 1.
Detrusor contraction in bladder exstrophy (BE) patients following reconstruction is poorly understood as there are few published studies assessing urodynamic findings in this population. Understanding the ability of the detrusor to contract in BE patients early after closure may be able to inform the longer-term management and potential for the development of future continence in this population.
We sought to evaluate early detrusor contraction using urodynamic studies (UDS) in children who had previously undergone complete primary repair of bladder exstrophy (CPRE). We hypothesized that a majority of children with BE would display the presence of normal detrusor contractile function after CPRE.
A retrospective review of our prospectively collected database was performed for all patients with a diagnosis of classic BE who underwent primary CPRE between 2013 and 2017. From this cohort we identified patients with at least one post-operative UDS at 3 years of age or older who had undergone an initial CPRE. Our primary outcome was the presence of a detrusor contraction demonstrated on UDS.
There were 50 children (31 male, 19 female) with CBE who underwent CPRE between 2013 and 2017.There were 26 (13 male, 13 female) who met inclusion criteria. Median age was 3.5 (IQR: 3.2-4.7) years at the time of UDS Sixteen of the 26 (61.5%) generated a sustained detrusor contraction generating a void, with a median peak voiding pressure of 38 cm H20 (IQR: 28-51). The median bladder capacity reached was 48 ml, which represented a median of 30% of expected bladder capacity. The median post void residual (PVR) for the entire cohort was 26 ml (IQR: 9, 47) or 51% (IQR: 20%-98%) of their actual bladder capacity, while the median PVR for those children with a sustained detrusor contraction was 18 ml (IQR: 5, 46) or 33% (IQR: 27%, 98%) of their actual bladder capacity. Intraoperative bladder width and bladder dome to bladder neck length did not correlate with the presence of voiding via a detrusor contraction (p = 0.64).
We present the first study assessing early UDS finding of detrusor contraction in BE patients after CPRE. In our cohort, 61.5% of patients were able to generate a sustained detrusor contraction on UDS which is a higher percentage than has been reported in previous series. A difference in initial surgical management may account for these findings.
At short term follow up, the majority of children in our cohort were able to produce sustained detrusor contractions sufficient to generate a void per urethra with a modest post void residual volume. Long-term follow-up and repeated UDS will be needed to track detrusor contractility rates, bladder capacities, compliance, post void residuals and ultimately continence rates over time.
由于发表的评估该人群尿动力学发现的研究较少，因此对重建后膀胱外翻（BE）患者膀胱收缩的了解甚少。了解膀胱在 BE 患者早期闭合后的收缩能力，可能有助于为该人群的长期管理和未来控尿能力提供信息。
我们旨在通过尿动力学研究（UDS）评估先前接受过完全原发性膀胱外翻修复术（CPRE）的患儿的早期膀胱收缩功能。我们假设大多数 BE 患儿在 CPRE 后会表现出正常的膀胱收缩功能。
对 2013 年至 2017 年间接受 CPRE 的经典 BE 患者的前瞻性数据库进行了回顾性分析。从该队列中，我们确定了至少有一次术后 UDS 在 3 岁或以上且接受过初始 CPRE 的患者。我们的主要结果是 UDS 显示存在逼尿肌收缩。
共有 50 名（31 名男性，19 名女性）患有 CBE 的患者接受了 2013 年至 2017 年之间的 CPRE。有 26 名（13 名男性，13 名女性）符合纳入标准。UDS 时的中位年龄为 3.5（IQR：3.2-4.7）岁。26 名患者中的 16 名（61.5%）产生了持续的逼尿肌收缩，产生了尿液，最大排尿压力中位数为 38 cm H20（IQR：28-51）。达到的中位膀胱容量为 48ml，代表预期膀胱容量的 30%。整个队列的中位残余尿量（PVR）为 26ml（IQR：9，47）或实际膀胱容量的 51%（IQR：20%-98%），而那些持续逼尿肌收缩的患儿的中位残余尿量为 18ml（IQR：5，46）或实际膀胱容量的 33%（IQR：27%，98%）。术中膀胱宽度和膀胱穹顶至膀胱颈长度与逼尿肌收缩时的排尿能力无关（p=0.64）。
我们首次报告了 CPRE 后 BE 患者早期 UDS 逼尿肌收缩的评估结果。在我们的队列中，61.5%的患者能够在 UDS 上产生持续的逼尿肌收缩，这一比例高于以前的系列报告。初始手术管理的差异可能导致了这些发现。
在短期随访中，我们队列中的大多数患儿能够产生足够的持续逼尿肌收缩，通过尿道产生尿液，并伴有适度的残余尿量。需要长期随访和重复 UDS 来跟踪逼尿肌收缩率、膀胱容量、顺应性、残余尿量，并最终跟踪随时间推移的控尿率。
