Wang Bingrui,Zhang Qian,Li Ji,et al.Analysis of augmentation cystoplasty plus ureter reimplantation for children with neurogenic bladder[J].Journal of Clinical Pediatric Surgery,,21():968-973.[doi:10.3760/cma.j.cn101785-202201019-012]
Analysis of augmentation cystoplasty plus ureter reimplantation for children with neurogenic bladder
- Keywords:
- Neurogenic Bladder; Augmentation Cystoplasty; Ureter Reimplantation; Vesicoureteral Reflux; Treatment Outcome; Child
- Abstract:
- Objective To explore the efficacy of augmentation cystoplasty and simultaneous ureteral reimplantation for neurogenic bladder in children with concurrent ureteral reflux.Methods From January 2014 to August 2020,36 children with neurogenic bladder and vesicoureteral reflux were recruited.According to whether or not ureteral reimplantation was performed simultaneously as augmentation cystoplasty,they were divided into two groups of augmentation cystoplasty (group A,n=22,33 ureters) and augmentation cystoplasty plus ureter reimplantation (group B,n=14,18 ureters).No significant inter-group differences existed in age,gender,grade of vesicoureteral reflux,past history or clinical symptoms (P>0.05).Operative duration,intraoperative blood loss and postoperative hospital stay were compared between two groups.The changes of bladder volume,bladder compliance,maximal detrusor pressure,residual rate of ureteral reflux,urinary tract infection rate and distal ureteral diameter ratio were compared between two groups before and after operation.Results Operation was successful in all children.Significant inter-group differences existed in operative duration [(152.6±24.4) min vs.(232.4±44.9) min]and residual rate of postoperative ureteral reflux (57.58% vs.16.67%)(P<0.05).No significant difference existed in intraoperative blood loss [(19.8±4.8) ml vs.(21.1±5.3) ml],postoperative hospital stay [(30.2±6.5) days vs.(29.6±5.1) days]and rate of recurrent febrile urinary tract infection (22.73% vs.14.29%) (P>0.05).No significant inter-group difference existed in ratio of distal ureter diameter before and after operation (P>0.05).The inter-group difference was statistically significant before and after operation (Z=3.01,P=0.003).Significant inter-group differences existed in bladder volume,bladder compliance and maximal detrusor pressure (P<0.001).During a follow-up period of 12 to 36 months,one case of bladder fistula occurred in both groups and recovered after indwelling urinary catheter.In group A,one case became cured after ureter reimplantation due to continuous bilateral vesicoureteral reflux.One case in group B was cured after abdominal exploration due to peritoniti and there was no obstruction of ureter bladder junction.Conclusion For children with neurogenic bladder with vesicoureteral reflux,augmentation cystoplasty plus ureter reimplantation is both safe and effective.It can reduce bladder detrusor pressure,improve bladder volume and bladder compliance,reduce the residual rate of postoperative ureteral reflux,distal ureteral diameter ratio.It does not increase the length of hospital stay and intraoperative blood loss.For children with neurogenic bladder with vesicoureteral junction obstruction or ureteral reflux,especially severe vesicoureteral reflux (high-grade reflux or/and low-pressure reflux),it is feasible to correct the existing ureteral reflux through augmentation cystoplasty and ureter reimplantation simultaneously.
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Memo
收稿日期:2022-1-10。
基金项目:河南省医学科技攻关计划联合共建项目(LHGJ20190299)
通讯作者:张谦,Email:shanyan@zzu.edu.cn