Diseth T H, Bjordal R, Schultz A, Stange M, Emblem R
Division of Child and Adolescent Psychiatry, National Hospital, Oslo, Norway.
J Urol. 1998 May;159(5):1684-9; discussion 1689-90. doi: 10.1097/00005392-199805000-00092.
We report the long-term somatic outcome, mental health and psychosocial adjustment in adolescents with bladder exstrophy and epispadias.
A total of 22 adolescents 11 to 20 years old (median age 14.5), including 19 with bladder exstrophy and 3 with epispadias, were assessed for urogenital status, stoma, renal and bowel function, anorectal physiology, mental health and psychosocial functioning by physical examinations, semistructured interviews and standardized questionnaires. The parents of 21 patients were interviewed and completed questionnaires. Information was also obtained on control groups.
Of the 22 patients 9 (41%) had no urinary diversion and were urinary incontinent, 6 (27%) had persistent fecal staining and anal canal pressures that were lower than the controls, 10 (59%) were dissatisfied with the penile appearance and 11 (50%) met the criteria for psychiatric diagnoses. The main predictors of mental health were parental warmth and patient genital appraisal in the 11 to 14-year age group, and parental warmth and urinary continence function in the 15 to 20-year age group. Psychosocial dysfunction was predicted by fecal incontinence in the younger group and worries about future sexual relationships in the older group.
The present multimodal outcome study revealed that adolescents with bladder exstrophy and epispadias had significant physical and mental problems. Genital malformation, and urinary and fecal incontinence may have a negative impact on mental health and psychosocial functioning. Our findings emphasize the need to include psychosocial experts on health care teams to reveal the amount of distress caused by these anomalies and to offer psychosocial support.
我们报告膀胱外翻和尿道上裂青少年的长期躯体结局、心理健康及社会心理适应情况。
对22名年龄在11至20岁（中位年龄14.5岁）的青少年进行评估，其中包括19名膀胱外翻患者和3名尿道上裂患者，通过体格检查、半结构化访谈及标准化问卷对其泌尿生殖系统状况、造口、肾脏和肠道功能、肛门直肠生理、心理健康及社会心理功能进行评估。对21名患者的父母进行访谈并让他们完成问卷。还获取了对照组的信息。
22名患者中，9名（41%）未进行尿流改道且尿失禁，6名（27%）有持续性粪便污染且肛管压力低于对照组，10名（59%）对阴茎外观不满意，11名（50%）符合精神疾病诊断标准。心理健康的主要预测因素在11至14岁年龄组为父母的温情及患者对生殖器的评价，在15至20岁年龄组为父母的温情及尿失禁功能。社会心理功能障碍在较年轻组由大便失禁预测，在较年长组由对未来性关系的担忧预测。
目前的多模式结局研究表明，膀胱外翻和尿道上裂青少年存在显著的身心问题。生殖器畸形、尿失禁和大便失禁可能对心理健康和社会心理功能产生负面影响。我们的研究结果强调，医疗团队需要纳入社会心理专家，以揭示这些异常所导致的痛苦程度并提供社会心理支持。
