Montagnino B, Czyzewski D I, Runyan R D, Berkman S, Roth D R, Gonzales E T
Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
J Urol. 1998 Oct;160(4):1471-4.
We explored the psychological adjustment of children with bladder or cloacal exstrophy.
We assessed 29 subjects with a mean age plus or minus standard deviation of 7.8 +/- 3.97 years using age appropriate standard psychological instruments. Psychological adjustment scores in the exstrophy group were compared to the norms of the various instruments. Subjects were divided into dichotomous groups according to several medical and demographic factors. For each factor the differences between the means of the 2 groups on the outcome variables were calculated using a t test.
Children with exstrophy perceived their appearance more positively than the norm. Older children performed more poorly than younger children in adaptive behavior, specifically in skills related to functioning in school. Children who achieved continence after age 4 years were more likely to have problems with acting out behavior. There were no differences in adjustment in boys versus girls, bladder versus cloacal exstrophy, type of continence strategy or gender reassignment versus no reassignment.
Children with exstrophy did not have clinical psychopathology. Differences existed in adaptive and acting out behavior rather than depression or anxiety, suggesting that improved outcomes may be achieved through a focus on normal adaptation rather than on potential psychological distress.
我们探讨了膀胱外翻或泄殖腔外翻患儿的心理调适情况。
我们使用适合年龄的标准心理测评工具对29名平均年龄为7.8±3.97岁（均值±标准差）的受试者进行了评估。将外翻组的心理调适得分与各测评工具的常模进行比较。根据多种医学和人口统计学因素将受试者分为二分法组。对于每个因素，使用t检验计算两组在结局变量上的均值差异。
外翻患儿对自身外貌的看法比常模更为积极。年龄较大的儿童在适应性行为方面表现不如年龄较小的儿童，特别是在与学校功能相关的技能方面。4岁后实现控尿的儿童更有可能出现行为失控问题。在男孩与女孩、膀胱外翻与泄殖腔外翻、控尿策略类型或性别重新分配与未重新分配之间，调适情况没有差异。
外翻患儿没有临床精神病理学问题。在适应性和行为失控行为方面存在差异，而非抑郁或焦虑，这表明通过关注正常适应而非潜在的心理困扰，可能会取得更好的结果。
