Decombe O, Lecoanet P, Montazeaud A, Lienard J, Larmure O, Gomola V, Hage L, Eschwege P, Lemelle J-L, Mazeaud C, Berte N
Department of Urology, CHRU Nancy, Université de Lorraine, Nancy, France.
Department of Pediatric Surgery, CHRU Nancy, Université de Lorraine, Nancy, France.
J Pediatr Urol. 2025 Jul 19. doi: 10.1016/j.jpurol.2025.07.018.
In patients who cannot perform intermittent self-catheterization via the urethra, continent cutaneous urinary diversion (CCUD) represents a valuable alternative, often associated with enterocystoplasty (EC). The CCUD is created using the appendix or the ileum, which can be implanted into the native bladder (NB) or the EC using various surgical techniques. This study aimed to evaluate postoperative outcomes and functional results of CCUD according to these two surgical approaches.
We conducted a retrospective, single-center study that included patients who underwent CCUD creation between 1991 and 2020. Clinical characteristics were compared using Fisher's exact test and the Mann-Whitney test. Postoperative complications were analyzed using Kaplan-Meier survival curves and compared using the Log-rank test.
A total of 94 patients were included (60 children, 34 adults): 74 (79 %) CCUD were implanted into the native detrusor (NB group), and 20 (21 %) onto the anterior wall of the enterocystoplasty (EC group). Early complications occurred on average at 7.5 days [7-11.5], with an overall rate of 5 %. Forty patients (42 %) experienced at least one long-term complication (e.g., leakage, stenosis, kinks), with no significant difference between groups. Survival analysis revealed no significant difference in overall surgical revisions (NB: 42 %, EC: 46 %; p = 0.51) or endoscopic revision. However, the EC group had significantly more frequent subfascial revision procedures (p = 0.005) and less frequent superficial stoma revision (p = 0.02), but this was not significant on multivariate analysis. At the end of follow-up (median: 12 years [7-21]), 82 % of patients remained continent (NB: 83 %, EC: 75 %).
A short and straight abdominal segment of the CCUD appears to reduce complication rates, as recommended by the technique involving implantation into a detrusor flap. However, preservation of the native bladder may contribute to persistent overactivity. The study is limited by its low external validity and the heterogeneity of patient characteristics, which may reduce statistical power. Nevertheless, the results reflect a real-life experience with a complex and uncommon surgical procedure.
Implantation of the conduit into the native bladder seems to be associated with better long-term continence outcomes and fewer subfascial revisions despite multiple confounding factors. Further studies are needed to refine surgical techniques and reduce complications.
对于无法通过尿道进行间歇性自我导尿的患者，可控性皮肤膀胱改道术（CCUD）是一种有价值的替代方法，通常与肠膀胱扩大术（EC）相关。CCUD可使用阑尾或回肠构建，通过各种手术技术植入天然膀胱（NB）或EC。本研究旨在根据这两种手术方法评估CCUD的术后结果和功能效果。
我们进行了一项回顾性单中心研究，纳入了1991年至2020年间接受CCUD构建的患者。使用Fisher精确检验和Mann-Whitney检验比较临床特征。使用Kaplan-Meier生存曲线分析术后并发症，并使用对数秩检验进行比较。
共纳入94例患者（60例儿童，34例成人）：74例（79%）CCUD植入天然逼尿肌（NB组），20例（21%）植入肠膀胱扩大术的前壁（EC组）。早期并发症平均发生在7.5天[7 - 11.5]，总体发生率为5%。40例患者（42%）经历了至少一种长期并发症（如渗漏、狭窄、扭结），两组之间无显著差异。生存分析显示，总体手术翻修（NB：42%，EC：46%；p = 0.51）或内镜翻修无显著差异。然而，EC组的筋膜下翻修手术更频繁（p = 0.005），浅表造口翻修更不频繁（p = 0.02），但在多因素分析中不显著。在随访结束时（中位时间：12年[7 - 21]），82%的患者保持控尿（NB：83%，EC：75%）。
如将CCUD植入逼尿肌瓣的技术所推荐的，CCUD较短且直的腹部段似乎可降低并发症发生率。然而，保留天然膀胱可能导致持续性过度活动。本研究受限于其低外部效度和患者特征的异质性，这可能降低统计效能。尽管如此，结果反映了一种复杂且不常见手术的真实临床经验。
尽管存在多种混杂因素，但将导管植入天然膀胱似乎与更好的长期控尿结果和更少的筋膜下翻修相关。需要进一步研究以优化手术技术并减少并发症。
