同期行后尿道瓣膜消融术和膀胱颈切开术可能降低首发时存在膀胱颈肥厚和膀胱功能不良的患者在长期随访中的肾和膀胱衰竭风险：301 例报告。
Simultaneous primary posterior urethral valves ablation and bladder neck incision may decrease kidney and bladder failure in long-term follow-up in patients with bladder neck hypertrophy and poor bladder function at presentation: report of 301 cases.
机构信息
Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran.
School of Public Health, Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
BMC Urol. 2024 Jul 29;24(1):154. doi: 10.1186/s12894-024-01546-0.
OBJECTIVES
To investigate the effects of bladder neck incision (BNI) and primary valves ablation on long-term kidney and bladder function in children with posterior urethral valves (PUV) and bladder neck hypertrophy (BNH).
PATIENTS AND METHODS
From 1997 to 2016, a total of 1381 children with PUV were referred to our tertiary hospital. Of these patients, 301 PUV patients with bladder neck hypertrophy need concurrent BNI and valve ablation. All patients were followed up every 3-6 months on regular basis in first 2 post-surgical years and annually then after. The paired t-test and chi-square test were used to perform statistical analysis with p value < 0.05 defined as the level of significance.
RESULTS
Mean age at diagnosis was 7.22 ± 2.45 months (ranging from 7 days to 15 months) with a mean follow-up of 5.12 ± 2.80 years. The incidence of hydronephrosis was decreased from 266 (88.3%) at the baseline to 73 (24.3%) patients in long-term follow-up. At baseline, 188 (62.5%) patients were diagnosed with VUR, which decreased to 20 (6.6%) individuals at the end of follow-up. Bladder and renal function were improved in follow-ups following concomitant PUV ablation and BNI. No Myogenic failure was depicted in all patients with BNH. No ureteric reimplantation was needed during the two decades follow-up.
CONCLUSION
Simultaneous valve ablation with BNI may present further profits in children with PUV and BNH particularly cases of BNH with poor bladder function at the time of presentation. This method can improve the results of urodynamic and imaging studies after the surgery. We hypothesize every child with PUV presentation who has concurrent vesicoureteral reflux, CKD or persistent hydrourethronephrosis may suffer from secondary bladder neck obstruction. This secondary bladder outlet obstruction must be managed through BNI as the surgical relief.
目的
探讨膀胱颈部切开术（BNI）和原发性瓣膜消融术对伴有膀胱颈部肥厚（BNH）的后尿道瓣膜（PUV）患儿长期肾脏和膀胱功能的影响。
方法
1997 年至 2016 年，共有 1381 例 PUV 患儿被转诊至我们的三级医院。其中，301 例 PUV 合并膀胱颈部肥厚患者需要行 BNI 及瓣膜消融术。所有患者在术后前 2 年每 3-6 个月定期随访一次，之后每年随访一次。采用配对 t 检验和卡方检验进行统计学分析，p 值<0.05 定义为有统计学意义。
结果
平均诊断年龄为 7.22±2.45 个月（范围为 7 天至 15 个月），平均随访时间为 5.12±2.80 年。肾积水的发生率从基线时的 266 例（88.3%）降至长期随访时的 73 例（24.3%）。基线时，188 例（62.5%）患者诊断为 VUR，随访结束时降至 20 例（6.6%）。同时行 PUV 消融和 BNI 可改善随访时的膀胱和肾功能。所有 BNH 患者均未出现肌源性失代偿。在 20 年的随访期间，无需行输尿管再植术。
结论
对于合并 PUV 和 BNH 的患儿，特别是在发病时膀胱功能不佳的 BNH 患儿，同时行瓣膜消融和 BNI 可能会带来更多益处。该方法可改善术后尿动力学和影像学研究的结果。我们假设，每个伴有膀胱输尿管反流、CKD 或持续性上尿路扩张的 PUV 患儿，都可能患有继发性膀胱颈梗阻。这种继发性膀胱出口梗阻必须通过 BNI 进行治疗。
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