Van der Merwe Elmarie, Loveday Rosy, Jackson Laura, McCarthy Liam
Department of Paediatric Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH UK.
Department of Paediatric Urology, Bristol Children's Hospital, Upper Maudlin St, Bristol BS2 8BJ, UK.
J Pediatr Surg. 2025 Mar;60(3):162050. doi: 10.1016/j.jpedsurg.2024.162050. Epub 2024 Nov 4.
Some children require long-term drainage of the bladder but do not tolerate clean intermittent catheterisation (CIC) urethrally. We aimed to compare long term suprapubic catheter (SPC) drainage vs Mitrofanoff conduit (allowing CIC) by comparing the survival of the drainage methods and rates of urinary tract infection (UTI).
Retrospective review of a single surgeon's experience (2007-2023). Data collection included diagnosis, age at procedures, date of surgery, date of most recent follow-up and date and reason for unplanned surgery. For SPCs, initial insertion of SPC and then conversion to a Foley catheter under GA was taken as normal (event free survival) and only further operations were counted as complication events. For Mitrofanoffs, any subsequent operation was counted as a complication. Data were given as a number (%) or median (interquartile range) as appropriate. Data analysed by Fisher exact and Mann-Whitney U-test. Kaplan Meier (KM) survival of drainage routes was compared, P < 0.05 taken as significant.
There were 45 patients (n = 86 SPC episodes) compared to 108 patients (n = 110 Mitrofanoff procedures). Data were available in 73 SPC episodes and 109 Mitrofanoff episodes, including 3 redo procedures (one from another centre). There was no difference in gender (SPC group, 67 % male vs. Mitrofanoff group, 77 %; N.S.). There was no difference in age at procedure [7.5 (2.9-11.5) years vs 8.3 (5.9-11.4) years respectively; N.S.) KM comparison showed that Mitrofanoff have a better event-free survival than SPC (91 % vs 52 % at 1 year; 80 % vs. 13 % at 5 years; P < 0.0001). Paired data showed a significant (86 %) reduction in rate of UTI with conversion from SPC to Mitrofanoff drainage in 15 patients; SPC: 0.13 (0-0.46) UTIs/month vs subsequent Mitrofanoff: 0.02 (0-0.08) UTI/month, P = 0.04).
SPCs had a much higher rate of unplanned surgery than Mitrofanoffs, creating a considerable unplanned burden of care for families and clinical staff. For long-term bladder drainage CIC via a Mitrofanoff conduit should be considered in preference to SPC where urethral CIC is not possible.
一些儿童需要长期进行膀胱引流，但无法耐受经尿道清洁间歇性导尿（CIC）。我们旨在通过比较引流方法的留存率和尿路感染（UTI）发生率，对比长期耻骨上膀胱造瘘管（SPC）引流与米氏可控性膀胱造瘘术（允许进行CIC）。
回顾性分析一位外科医生（2007年至2023年）的经验。数据收集包括诊断结果、手术时年龄、手术日期、最近一次随访日期以及非计划手术的日期和原因。对于SPC，将最初插入SPC然后在全身麻醉下转换为Foley导尿管视为正常（无事件留存），仅将进一步的手术计为并发症事件。对于米氏可控性膀胱造瘘术，任何后续手术均计为并发症。数据根据情况以数字（%）或中位数（四分位间距）表示。采用Fisher精确检验和Mann-Whitney U检验进行数据分析。比较引流途径的Kaplan Meier（KM）留存率，P < 0.05为有显著差异。
45例患者（86次SPC事件）与108例患者（110次米氏可控性膀胱造瘘术）进行了比较。73次SPC事件和109次米氏可控性膀胱造瘘术事件有可用数据，包括3例再次手术（1例来自另一个中心）。性别无差异（SPC组，67%为男性，米氏可控性膀胱造瘘术组为77%；无统计学意义）。手术时年龄无差异[分别为7.5（2.9 - 11.5）岁和8.3（5.9 - 11.4）岁；无统计学意义]。KM比较显示，米氏可控性膀胱造瘘术的无事件留存率优于SPC（1年时为91%对52%；5年时为80%对13%；P < 0.0001）。配对数据显示，15例患者从SPC转换为米氏可控性膀胱造瘘术引流后，UTI发生率显著降低（86%）；SPC：0.13（0 - 0.46）次UTI/月，后续米氏可控性膀胱造瘘术：0.02（0 - 0.08）次UTI/月，P = 0.04）。
SPC的非计划手术发生率远高于米氏可控性膀胱造瘘术，给家庭和临床工作人员带来了相当大的非计划护理负担。对于长期膀胱引流，在无法进行经尿道CIC的情况下，应优先考虑通过米氏可控性膀胱造瘘管进行CIC，而非SPC。
