Waters P R, Chehade N C, Kropp K A
Department of Urology, Medical College of Ohio, Toledo.
J Urol. 1997 Sep;158(3 Pt 2):1053-6.
Creation of a 1-way catheterizable valve has resulted in dryness for a large group of children with intractable urinary incontinence. We document the incidence, time course and management of catheterization problems in 49 children who underwent urethral lengthening and reimplantation for intractable incontinence.
We reviewed the records of 21 boys and 28 girls who underwent urethral lengthening and reimplantation between 1982 and 1995. Catheterization problems were defined as the inability of the patient or a family member to pass the catheter, and divided into early only, late only, recurrent and persistent problems.
Of the 49 patients 46 had neurogenic incontinence secondary to myelomeningocele and 35 (72%) never had difficulty catheterizing. Of the 14 children (28%) who had difficulty 7 (50%) were boys and 7 (50%) were girls. Two children (4%) with early only difficult catheterization have had no further difficulties during the last 14 and 6 years, respectively. In 3 children (6%) late only difficult catheterization began 17, 24 and 35 months, respectively, after the original bladder neck surgery. These problems were solved by changing to a Coudé catheter and/or avoiding over distension. The 7 patients (14%) with recurrent catheterization problems, some with long intervals between episodes, now catheterize easily. The 2 children (4%) with persistent problems required alternate access to the bladder.
The majority of children (72%) who undergo urethral lengthening and reimplantation never have any difficulty catheterizing. Those in whom difficult catheterization develops can be treated with minimally invasive methods without compromising the goals of the original surgery.
单向可导尿瓣膜的发明使大量顽固性尿失禁患儿实现了干爽。我们记录了49例因顽固性尿失禁接受尿道延长和再植术的患儿的导尿问题发生率、时间进程及处理情况。
我们回顾了1982年至1995年间21例男孩和28例女孩接受尿道延长和再植术的记录。导尿问题定义为患者或家庭成员无法插入导尿管，并分为仅早期、仅晚期、复发性和持续性问题。
49例患者中，46例继发于脊髓脊膜膨出的神经源性尿失禁，35例（72%）从未有过导尿困难。14例（28%）有困难的患儿中，7例（50%）为男孩，7例（50%）为女孩。2例（4%）仅早期导尿困难的患儿，分别在过去14年和6年中未再出现困难。3例（6%）仅晚期导尿困难的患儿，分别在原膀胱颈手术后17、24和35个月出现问题。通过更换为弯头导尿管和/或避免过度扩张解决了这些问题。7例（14%）有复发性导尿问题的患者，有些发作间隔时间较长，现在导尿很容易。2例（4%）有持续性问题的患儿需要改用其他方式进入膀胱。
大多数接受尿道延长和再植术的患儿（72%）导尿从未有任何困难。出现导尿困难的患儿可以采用微创方法治疗，而不会影响原手术的目标。
