Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
Research Team for the Establishment of Treatment Guidelines for Persistent Cloaca, Cloacal Exstrophy and Mayer-Rokitansky-Küster-Häuser Syndrome for the Proper Transitional Care of the Patients, The Research Project for Rare and Intractable Diseases, Ministry of Health, Labour and Welfare (MHLW), Tokyo, Japan.
Pediatr Surg Int. 2024 Jul 6;40(1):177. doi: 10.1007/s00383-024-05763-4.
We investigated the postoperative renal function in persistent cloaca (PC) patients who underwent posterior sagittal anorecto-urethro-vaginopalsty (PSARUVP) and factors influencing the renal functional outcomes.
A questionnaire survey was distributed to 244 university and children's hospitals across Japan. Of the 169 patients underwent PSARUVP, 103 patients were enrolled in the present study. Exclusion criteria was patients without data of renal prognosis.
The present study showed that renal anomalies (p = 0.09), vesicoureteral reflux (VUR) (p = 0.01), and hydrocolpos (p = 0.07) were potential factors influencing a decline in the renal function. Approximately half of the patients had a normal kidney function, but 45.6% had a reduced renal function (Stage ≥ 2 chronic kidney disease: CKD). The incidence of VUR was significantly higher in the renal function decline (RFD) group than those in the preservation (RFP) group (p = 0.01). Vesicostomy was significantly more frequent in the RFD group than in the RFP group (p = 0.04). Urinary tract infections (p < 0.01) and bladder dysfunction (p = 0.04) were significantly more common in patients with VUR than in patients without VUR. There was no association between the VUR status and the bowel function.
Prompt assessment and treatment of VUR along with bladder management may minimize the decline in the renal function.
我们调查了接受后路矢状直肠肛门尿道阴道成形术（PSARUVP）的持续性肛膜（PC）患者的术后肾功能以及影响肾功能结果的因素。
我们向日本 244 所大学医院和儿童医院发放了一份问卷调查。在接受 PSARUVP 的 169 名患者中，有 103 名患者被纳入本研究。排除标准为无肾功能预后数据的患者。
本研究表明，肾脏异常（p=0.09）、膀胱输尿管反流（VUR）（p=0.01）和阴囊肿水（p=0.07）是肾功能下降的潜在影响因素。大约一半的患者肾功能正常，但 45.6%的患者肾功能下降（≥2 期慢性肾脏病：CKD）。肾功能下降（RFD）组的 VUR 发生率明显高于肾功能保留（RFP）组（p=0.01）。RFD 组的膀胱造口术明显多于 RFP 组（p=0.04）。VUR 患者的尿路感染（p<0.01）和膀胱功能障碍（p=0.04）明显多于无 VUR 患者。VUR 状态与肠道功能之间无相关性。
及时评估和治疗 VUR 并进行膀胱管理可能会最大限度地减少肾功能下降。
