Gearhart J P, Mathews R, Taylor S, Jeffs R D
Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.
J Urol. 1998 Sep;160(3 Pt 2):1182-5; discussion 1190. doi: 10.1097/00005392-199809020-00062.
Children with bladder exstrophy in whom initial closure fails are less likely to achieve adequate bladder capacity for later bladder neck reconstruction and continence. Repeat bladder closure may be combined with epispadias repair as initial management, decreasing the need for repeat anesthesia as well as providing increased outlet resistance to permit bladder growth in preparation for later bladder neck reconstruction. We compared results in boys who underwent combined bladder closure and epispadias repair or staged reconstruction.
A total of 16 boys with a mean age of 22 months with bladder exstrophy were referred for bladder closure after previous closure had failed in 15 and for delayed primary closure in 1. Osteotomies were performed in all patients, with bladder closure and epispadias repair as initial treatment. Results were compared to those in 21 boys with a mean age of 26 months in whom exstrophy closure had failed, and who underwent standard staged reconstruction by repeat closure followed by epispadias repair and subsequent bladder neck reconstruction in those who achieved adequate bladder capacity.
At a mean followup of 87 months fistula rates were similar in the 2 groups. Eventual bladder neck reconstruction was possible in 69% of the patients in each group. In addition, 2 boys in the combined repair group achieved continence before bladder neck reconstruction was performed.
We recommend epispadias repair combined with bladder exstrophy closure for treating failed exstrophy closure or late initial closure. Operative complications and results are comparable to those in patients in whom previous exstrophy closure failed and who undergo standard staged repair.
初次膀胱关闭失败的膀胱外翻患儿，日后膀胱颈重建及实现控尿所需的膀胱容量达标可能性较低。重复膀胱关闭可与阴茎头型尿道上裂修复联合作为初始治疗，减少重复麻醉的需求，并增加出口阻力，以促进膀胱生长，为日后膀胱颈重建做准备。我们比较了接受膀胱关闭与阴茎头型尿道上裂联合修复或分期重建的男孩的治疗结果。
共有16名平均年龄22个月的膀胱外翻男孩因之前15例初次膀胱关闭失败及1例延迟初次关闭而前来接受膀胱关闭治疗。所有患者均进行了截骨术，初始治疗为膀胱关闭与阴茎头型尿道上裂修复。将结果与21名平均年龄26个月的男孩进行比较，这些男孩膀胱外翻关闭失败，接受了标准分期重建，即重复关闭，随后进行阴茎头型尿道上裂修复，对膀胱容量达标的患者进行后续膀胱颈重建。
平均随访87个月时，两组的瘘管发生率相似。每组69%的患者最终可行膀胱颈重建。此外，联合修复组有2名男孩在进行膀胱颈重建前实现了控尿。
我们建议阴茎头型尿道上裂修复联合膀胱外翻关闭用于治疗膀胱外翻关闭失败或初次关闭延迟的情况。手术并发症和结果与之前膀胱外翻关闭失败并接受标准分期修复的患者相当。
