Skobejko-Wlodarska L, Strulak K, Nachulewicz P, Szymkiewicz C
Department of Paediatric Urology, The Children's Memorial Health Institute, Warsaw, Poland.
Br J Urol. 1998 May;81 Suppl 3:114-6. doi: 10.1046/j.1464-410x.1998.00022.x.
To present the long-term results of bladder autoaugmentation in myelodysplastic children with low compliance neurogenic bladders who failed attempts at medical management, including clean intermittent catheterization (CIC) and pharmacological bladder relaxation.
Twenty-one patients with a neurogenic bladder after myelomeningocele operations (mean age 9.5 years, range 3-16) underwent autoaugmentation; 12 children were paraplegic and hydrocephalic, and were treated by insertion of a ventriculoperitoneal valve. All patients had low-compliance neurogenic bladders confirmed urodynamically. Ten patients had vesico-ureteric reflux (VUR) and eight had dilated upper urinary tracts with no reflux. All patients had been treated pre-operatively using CIC and anticholinergic agents, with no success.
Of 21 children treated surgically, 17 were assessed urodynamically and examined to determine the condition of the upper and lower urinary tract. The follow-up ranged from 3 months to 8 years (mean 6 years). In 13 patients the bladder capacity increased by approximately 60 mL and in 14 the intravesical pressure decreased by approximately 65 cmH2O. Fourteen children were continent using CIC (from 3- to 4-hourly); in the six patients with VUR the reflux resolved in two, decreased in two and remained unchanged in two. Of eight patients with dilated upper tracts but no reflux, seven improved. There was no improvement in bladder capacity in four patients and no reduction in intravesical pressure in three. Two patients underwent enterocystoplasty (one ileocystoplasty and one colocystoplasty) with good results. Two children needed anticholinergic agents after autoaugmentation.
Autoaugmentation effectively reduces high intravesical pressure and provides a sufficient increase in bladder capacity with a concomitant improvement in urodynamic values. The present method allows the extent of the surgical procedure to be limited to the extraperitoneal space and thus maintains all of other options. Bladder autoaugmentation is a reasonable alternative to enterocystoplasty in selected patients.
介绍膀胱自体扩大术治疗脊髓发育不良且膀胱顺应性低的神经源性膀胱患儿的长期结果，这些患儿药物治疗（包括清洁间歇性导尿（CIC）和膀胱药物松弛）失败。
21例脊髓脊膜膨出术后神经源性膀胱患者（平均年龄9.5岁，范围3 - 16岁）接受了自体扩大术；12例儿童为截瘫并伴有脑积水，通过插入脑室腹腔分流管进行治疗。所有患者经尿动力学证实存在低顺应性神经源性膀胱。10例患者有膀胱输尿管反流（VUR），8例上尿路扩张但无反流。所有患者术前均采用CIC和抗胆碱能药物治疗，但均未成功。
21例接受手术治疗的儿童中，17例进行了尿动力学评估并检查上下尿路情况。随访时间为3个月至8年（平均6年）。13例患者膀胱容量增加约60 mL，14例膀胱内压降低约65 cmH₂O。14例儿童通过CIC实现了控尿（每3 - 4小时一次）；6例VUR患者中，2例反流消失，2例反流减轻，2例无变化。8例上尿路扩张但无反流的患者中，7例病情改善。4例患者膀胱容量无改善，3例患者膀胱内压未降低。2例患者接受了肠膀胱扩大术（1例回肠膀胱扩大术和1例结肠膀胱扩大术），效果良好。2例儿童在自体扩大术后仍需要抗胆碱能药物。
自体扩大术可有效降低膀胱内高压，使膀胱容量充分增加，同时改善尿动力学指标。目前的方法可将手术范围限制在腹膜外间隙，从而保留所有其他选择。对于选定的患者，膀胱自体扩大术是肠膀胱扩大术的合理替代方法。
