Fuchs J, Glüer S, Mildenberger H
Department of Pediatric Surgery, Hannover Medical School, Germany.
Eur J Pediatr Surg. 1996 Aug;6(4):212-5. doi: 10.1055/s-2008-1066510.
From 1984 to 1990 a primary one-stage reconstruction of bladder exstrophy was performed at our hospital on 15 consecutive infants. Reconstruction included Cohen's ureteral reimplantation, bladder neck reconstruction according to Young-Dees, bladder closure, symphyseal bone approximation, abdominal wall closure, and repair of epispadias in females. Postoperatively, all patients were immobilized by overhead extension. Iliac osteotomy was done in 9 children, but was abandoned in recent years for infants less than one month old Follow-up examinations included an interview with the parents, clinical examinations, blood and urine analyses, uroflowmetry, and ultrasound scan of the abdomen. Nuclear renal scan, i.v. pyelography, and cystography were carried out as indicated. At the time of last evaluation the children were between 3 and 9 years of age. The cosmetic results were satisfactory in all cases. Eight of 15 children were dry day and night with micturition intervals more than 3 hours during day time (complete continence). Five children were dry during day time with micturition intervals up to 3 hours, but occasionally wet their beds (partial continence). Two children were incontinent. Eleven of 15 children had a bladder capacity of more than 100 ml. Renal function was normal in all patients. Two children showed a mild VUR, and no other abnormalities of the upper urinary tracts were found. Iliac osteotomy did not influence the functional or cosmetic results, but in two patients asymmetry of pelvic bones with consecutive lumbar scoliosis was found. Comparing these results with reports on staged reconstructive procedures, we conclude that by primary complete one-stage reconstruction a well acceptable success rate is achieved, and that by this method possibly some advantages are offered to patients with bladder exstrophy.
1984年至1990年，我院对15例连续性婴儿进行了膀胱外翻一期主要重建手术。重建包括科恩输尿管再植术、根据扬 - 迪斯法进行膀胱颈重建、膀胱闭合、耻骨联合骨靠拢、腹壁闭合以及女性尿道上裂修复。术后，所有患者均通过头高位伸展进行固定。9例儿童进行了髂骨截骨术，但近年来对于小于1个月的婴儿已放弃该术式。随访检查包括与家长面谈、临床检查、血液和尿液分析、尿流率测定以及腹部超声扫描。根据需要进行核素肾扫描、静脉肾盂造影和膀胱造影。在最后一次评估时，这些儿童年龄在3至9岁之间。所有病例的美容效果均令人满意。15名儿童中有8名白天和夜间均能自主排尿，白天排尿间隔超过3小时（完全控尿）。5名儿童白天能自主排尿，排尿间隔可达3小时，但偶尔尿床（部分控尿）。2名儿童尿失禁。15名儿童中有11名膀胱容量超过100毫升。所有患者肾功能均正常。2名儿童显示轻度膀胱输尿管反流，未发现上尿路其他异常。髂骨截骨术未影响功能或美容效果，但在2例患者中发现骨盆骨不对称并伴有连续性腰椎侧弯。将这些结果与分期重建手术的报告进行比较，我们得出结论，通过一期完全重建可获得良好的成功率，并且通过这种方法可能为膀胱外翻患者提供一些优势。
