Koo H P, Avolio L, Duckett J W
Division of Urology, Children's Hospital of Philadelphia, Pennsylvania, USA.
J Urol. 1996 Dec;156(6):2037-40.
We evaluated long-term results of patients with bladder exstrophy who underwent ureterosigmoidostomy.
Of 4 women and 23 men monitored at our institution 16 (59%) underwent primary diversion by ureterosigmoidostomy, while 11 (41%) underwent primary bladder closure or an ileal conduit procedure before conversion to ureterosigmoidostomy. Average followup after ureterosigmoidostomy was 17 years.
Significant upper urinary tract changes developed in 18% of the patients. Metabolic acidosis was well compensated in most patients but 2 had problems with urinary retention leading to hyperammonemia and acidosis. Of the 19 patients monitored with biennial colonoscopy benign polyps were removed in 4. Daytime continence was achieved in 92% of cases and nighttime continence in 58%.
Our experience with ureterosigmoidostomy in children with bladder exstrophy has been favorable through long-term followup. With proper imaging, metabolic surveillance, biennial colonoscopy and nonsteroidal anti-inflammatory drugs we offer ureterosigmoidostomy as a viable alternative for patients with small bladders.
我们评估了接受输尿管乙状结肠吻合术的膀胱外翻患者的长期疗效。
在我们机构接受监测的4名女性和23名男性中，16例（59%）接受了输尿管乙状结肠吻合术作为一期尿流改道，而11例（41%）在转为输尿管乙状结肠吻合术之前接受了一期膀胱闭合术或回肠代膀胱术。输尿管乙状结肠吻合术后的平均随访时间为17年。
18%的患者出现了明显的上尿路改变。大多数患者的代谢性酸中毒得到了良好的代偿，但有2例出现尿潴留问题，导致高氨血症和酸中毒。在接受每两年一次结肠镜检查监测的19例患者中，4例切除了良性息肉。92%的患者实现了日间控尿，58%的患者实现了夜间控尿。
通过长期随访，我们在膀胱外翻患儿中应用输尿管乙状结肠吻合术的经验是良好的。通过适当的影像学检查、代谢监测、每两年一次的结肠镜检查和非甾体类抗炎药，我们为膀胱较小的患者提供输尿管乙状结肠吻合术作为一种可行的选择。
