Morin Jacqueline P, Srinivas Shruthi, Wood Richard J, Dajusta Daniel G, Fuchs Molly E
Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
J Pediatr Surg. 2024 Aug;59(8):1647-1651. doi: 10.1016/j.jpedsurg.2024.04.010. Epub 2024 Apr 20.
Multiple factors impact ability to achieve urinary continence in cloacal malformation including common channel (CC) and urethral length and presence of spinal cord abnormalities. Few publications describe continence rates and bladder management in this population. We evaluated our cohort of patients with cloacal malformation to describe the bladder management and continence outcomes.
We reviewed a prospectively collected database of patients with cloacal malformation managed at our institution. We included girls ≥3 years (y) of age and evaluated their bladder management methods and continence. Dryness was defined as <1 daytime accident per week. Incontinent diversions with both vesicostomy and enterovesicostomy were considered wet.
A total of 152 patients were included. Overall, 93 (61.2%) are dry. Nearly half (47%) voided via urethra, 65% of whom were dry. Twenty patients (13.1%) had incontinent diversions. Over 40% of the cohort performed clean intermittent catheterization (CIC), approximately half via urethra and half via abdominal channel. Over 80% of those performing CIC were dry. In total, 12.5% (n = 19) required bladder augmentation (BA). CC length was not associated with dryness (p = 0.076), need for CIC (p = 0.253), or need for abdominal channel (p = 0.497). The presence of a spinal cord abnormality was associated with need for CIC (p = 0.0117) and normal spine associated with ability to void and be dry (p = 0.004) CONCLUSIONS: In girls ≥ 3 y of age with cloacal malformation, 61.2% are dry, 65% by voiding via urethra and 82% with CIC. 12.5% require BA. Further investigation is needed to determine anatomic findings associated with urinary outcomes.
IV.
多种因素影响泄殖腔畸形患者实现尿失禁的能力，包括共同通道（CC）、尿道长度和脊髓异常的存在。很少有出版物描述该人群的尿失禁率和膀胱管理情况。我们评估了我们的泄殖腔畸形患者队列，以描述膀胱管理和尿失禁结果。
我们回顾了在我们机构前瞻性收集的泄殖腔畸形患者数据库。我们纳入了年龄≥3岁的女孩，并评估了她们的膀胱管理方法和尿失禁情况。干爽定义为每周白天尿失禁少于1次。膀胱造瘘术和小肠膀胱造瘘术的失禁性改道被视为尿湿。
共纳入152例患者。总体而言，93例（61.2%）干爽。近一半（47%）经尿道排尿，其中65%干爽。20例患者（13.1%）进行了失禁性改道。超过40%的队列患者进行清洁间歇性导尿（CIC），约一半经尿道，一半经腹部通道。进行CIC的患者中超过80%干爽。共有12.5%（n = 19）需要膀胱扩大术（BA）。CC长度与干爽（p = 0.076）、CIC需求（p = 0.253）或腹部通道需求（p = 0.497）无关。脊髓异常的存在与CIC需求相关（p = 0.0117），而正常脊柱与排尿和干爽能力相关（p = 0.004）。结论：在年龄≥3岁的泄殖腔畸形女孩中，61.2%干爽，经尿道排尿者65%干爽，进行CIC者82%干爽。12.5%需要BA。需要进一步研究以确定与尿失禁结果相关的解剖学发现。
IV级。
