Zhang Zhibo,Li Xue,Kang Lei,et al.A primary study of female occult epispadias[J].Journal of Clinical Pediatric Surgery,,19():1002-1006.[doi:10.3969/j.issn.1671-6353.2020.11.008]
A primary study of female occult epispadias
- Keywords:
- Epispadias/SU; Urinary Incontinence; Female
- CLC:
- R695;R695.1;R694+.54
- Abstract:
- Objective To explore the morbidity,nomenclature,pathologic characteristics,diagnosis and treatment of special female epispadias with slight vulva changes.Methods Retrospective reviews were conducted for 14 girls with primary urinary incontinence between April 2006 and October 2018.The mean age was 6(4-11) years.All patients showed complete incontinence (grade 3) since birth and apparently normal external genitalia.Yet urethral meatus became widened with a short urethra of a mean length of (1.09±0.21)(0.8-1.5) cm.Both mucosal and vascular bladders were normal.The position and appearance of bilateral ureteral orifice were normal.Bladder capacity declined markedly with a mean volume of (79.16±20.25)(50-120) ml.Eleven cases underwent bladder neck placation (BNP) via a retro-symphyseal approach.Four cases underwent BNP alone initially and bladder neck suspension (BNS) was added for two cases 1 year postoperatively due to unsatisfactory results.And BNP plus BNS (n=7) and Young-Dees-Leadbetter procedure (YDL,n=3) were performed.Results A total 16 operations (including 2 re-operations) were performed successfully.And all cases were discharged normally.The mean follow-up period of 13 cases was 18(6-24) months.Among 11 cases undergoing BNP,urinary continence was grade 0 (n=4) and grade 1 (n=5).All 9 cases achieved satisfactory urinary continence.Another two achieved grade 3 after BNP and improved to grade 1 after BNP plus BNS at Year 1.One case was lost to follow-ups at Month 3 after reoperation.Three cases underwent YDL procedure.Urinary continence was grade 1 (n=2) and grade 2 (n=1).The latter one improved to grade 1 after 1-year training.Conclusion Inadequate awareness of female epispadias with slight vulva changes may result in missed diagnosis and underestimated incidence of female epispadias.The actual incidence rate is obviously higher than the figure of previous reports.Vulva changes may not match with damage extent of urinary sphincter.The key examination of diagnosing female occult epispadias is cystourethroscopy revealing short and wide urethra,expended bladder neck,low capacity bladder and low bladder leak point pressure.Bladder neck plasty is a major treatment while a combination of BNP and BNS is an effective supplement.
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Memo
收稿日期:2020-08-18。
基金项目:四川省科技计划重点研发项目（编号：2017SZ0060）
通讯作者:黄鲁刚,Email:lugang992001@163.com