Pérez L M, Smith E A, Parrott T S, Broecker B H, Massad C A, Woodard J R
Division of Urology, Emory University, Egleston Children's Hospital, Atlanta, Georgia, USA.
J Urol. 1996 Aug;156(2 Pt 2):633-6. doi: 10.1097/00005392-199608001-00016.
The surgical management of stress urinary incontinence in the pediatric population includes various surgical techniques of which the simplest is outpatient transurethral or periurethral injection of a bulking agent. Currently purified bovine dermal collagen cross-linked with glutaraldehyde (Contigen) is the only Food and Drug Administration approved bulking agent available. Patients with stable detrusor function are ideal candidates. We review our initial experience with children.
Between January 1994 and June 1995, 23 boys and 9 girls 4 to 17 years old (mean age 9) consecutively underwent submucosal bladder neck injection with cross-linked bovine dermal collagen. Incontinence was secondary to spinal dysraphism in 24 patients, complete epispadias in 4, classic bladder exstrophy in 3 and neurogenic bladder secondary to a sacral teratoma in 1. Preoperative video urodynamics documented intrinsic sphincteric deficiency in all patients with leak point pressure of 15 to 60 cm. water (mean 37). Injection volumes ranged from 2.5 to 17 cc (mean 10). Continence results were defined as dry-requiring no protection while on a 4-hour clean intermittent catheterization program, good-improved but requiring 1 to 5 pads daily and failure-no postoperative improvement or still requiring diapers.
Of the children with neurogenic bladder 20% became dry following the first injection and an additional 28% had a good result. Furthermore, of the 6 children with exstrophy or epispadias who underwent a Young-Dees-Leadbetter procedure 50% were dry and 17% had a good result after the first injection. Complications were limited to a febrile urinary tract infection associated with urinary retention in 1 patient and transiently worse continence in 2.
Despite the limited success rate, we believe that transurethral collagen injection therapy has a viable role in the treatment of intrinsic sphincteric deficiency in select pediatric patients, particularly since the procedure has low morbidity and can be performed on an outpatient basis. Preoperative counseling should be given with realistic expectations.
小儿压力性尿失禁的手术治疗包括多种手术技术，其中最简单的是门诊经尿道或尿道周围注射填充剂。目前，经戊二醛交联的纯化牛真皮胶原蛋白（Contigen）是唯一经美国食品药品监督管理局批准的可用填充剂。逼尿肌功能稳定的患者是理想的候选者。我们回顾了我们在儿童患者中的初步经验。
1994年1月至1995年6月，23名男孩和9名4至17岁（平均年龄9岁）的女孩连续接受了经黏膜膀胱颈注射交联牛真皮胶原蛋白治疗。24例尿失禁继发于脊髓发育不良，4例为完全性尿道上裂，3例为典型膀胱外翻，1例为骶尾部畸胎瘤继发神经源性膀胱。术前视频尿动力学检查显示所有患者均存在固有括约肌缺陷，漏尿点压力为15至60 cm水柱（平均37 cm水柱）。注射量为2.5至17 cc（平均10 cc）。控尿结果定义为：在4小时清洁间歇性导尿方案下无需保护即保持干爽为干爽；改善但每天仍需使用1至5片尿垫为良好；术后无改善或仍需使用尿布为失败。
神经源性膀胱患儿中，20%在首次注射后达到干爽，另有28%效果良好。此外，在接受Young-Dees-Leadbetter手术的6例膀胱外翻或尿道上裂患儿中，50%在首次注射后达到干爽，17%效果良好。并发症仅限于1例与尿潴留相关的发热性尿路感染和2例短暂性控尿恶化。
尽管成功率有限，但我们认为经尿道胶原蛋白注射疗法在治疗特定小儿患者的固有括约肌缺陷方面具有可行的作用，特别是因为该手术发病率低且可在门诊进行。应给予术前咨询并设定现实的期望。
