Gearhart J P, Peppas D S, Jeffs R D
Division of Paediatric Urology, Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Br J Urol. 1995 Jan;75(1):87-90. doi: 10.1111/j.1464-410x.1995.tb07241.x.
To determine the application and success of continent urinary stomas in the failed bladder exstrophy reconstruction.
A total of 35 patients underwent construction of a continent urinary stoma during bladder replacement or bladder augmentation between 1987 and 1993. The continent stoma was constructed with appendix (19 patients), tapered ileum (2), Benchekroun (12), Indiana (1) and Mainz type stoma (1).
Three patients required revision of their continent stoma, one for incontinence and two for difficulty in catheterization. Overall, 95% experienced daytime continence on an intermittent catheterization regimen, while 90% were dry at night. The upper tract remained normal in 34 of 35 patients.
While the Benchekroun technique is reliable in producing continence, difficulty with catheterization has been a chronic problem due to stomal stenosis. Our positive experience with using the appendix as a catheterizable conduit into either the bladder template or bowel segment has led us to prefer this method of continent stoma construction in the patient with a failed exstrophy. In the absence of an appendix, our preference is a tapered ileal segment. The failed exstrophy reconstruction can be salvaged with a continent stoma and substitution or augmentation cystoplasty in most patients, thus avoiding urinary diversion.
确定可控性尿流改道术在膀胱外翻重建失败中的应用及成功率。
1987年至1993年间，共有35例患者在膀胱替代或膀胱扩大术期间接受了可控性尿流改道术。可控性造口采用阑尾（19例患者）、锥形回肠（2例）、本切克鲁恩术式（12例）、印第安纳术式（1例）和 Mainz 型造口（1例）构建。
3例患者需要对其可控性造口进行修复，1例因尿失禁，2例因导尿困难。总体而言，95%的患者在间歇性导尿方案下白天能保持控尿，90%的患者夜间无尿失禁。35例患者中有34例上尿路保持正常。
虽然本切克鲁恩技术在实现控尿方面可靠，但由于造口狭窄，导尿困难一直是个长期问题。我们在将阑尾用作通向膀胱模板或肠段的可导尿管道方面的积极经验，使我们在膀胱外翻重建失败的患者中更倾向于采用这种可控性造口构建方法。若没有阑尾，我们更倾向于使用锥形回肠段。大多数患者可通过可控性造口以及替代或扩大膀胱成形术挽救膀胱外翻重建失败的情况，从而避免尿流改道。
