Augmentation cystoplasty in children with neuropathic bladder: long-term outcomes after 30 years experience.

IF 4.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Minerva Urology and Nephrology Pub Date : 2024-11-04 DOI:10.23736/S2724-6051.24.05919-6
Carlos Delgado-Miguel, Virginia Amesty, Susana Rivas, Roberto Lobato, María J Martínez-Urrutia, Pedro López-Pereira
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Abstract

Background: Augmentation cystoplasty (AC) is a useful alternative for the treatment of neuropathic bladder, although there are few studies reporting long-term results. We assess our experience over the last 30-years.

Methods: A retrospective study was conducted in patients with neuropathic bladder in whom AC was performed in our institution between 1990-2020. Demographic variables, pre- and post- AC urodynamic studies, long-term outcomes and postoperative complications were collected.

Results: Eighty-six patients (43 males and 43 females) underwent AC surgery with a median age of 12.8 years (interquartile range 9.6-15.1). Bladder augmentation was performed with ileum in 49 cases (57%), sigma in 32 cases (37.2%) and ureter in 5 cases (5.8%). In 27 patients an artificial urinary sphincter (AUS) was placed at the same intervention. The mean preoperative bladder capacity was 117 mL (SD 40), which was increased to 430 mL (SD 64) one year after surgery, this difference being statistically significant (P<0.001). Median follow-up was 24.5 years (interquartile range 17.5-26). Vesico-ureteral reflux improved after AC in 78.9% with no other surgical interventions. Seven mechanical complications associated with AUS were reported. Bladder lithiasis was reported in 9 patients. No bladder perforations were described. One patient developed bladder squamous cell carcinoma 16 years after AC, requiring radical cystectomy and Hautmann neobladder.

Conclusions: Long-term results of this study demonstrate that AC is an effective surgical treatment in patients with neuropathic bladder patients without proper response to medical treatment. The risk of developing complications long after bladder augmentation makes close clinical follow-up of these patients essential.

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神经性膀胱患儿的膀胱成形术:30 年后的长期疗效。
背景:增强膀胱成形术(AC)是治疗神经性膀胱的一种有效替代方法,但报告长期效果的研究很少。我们对过去 30 年的经验进行了评估:方法:我们对 1990-2020 年间在本院接受膀胱成形术的神经性膀胱患者进行了一项回顾性研究。收集了人口统计学变量、膀胱刺激术前和术后尿动力学检查、长期疗效和术后并发症:86名患者(43男43女)接受了膀胱刺激术,中位年龄为12.8岁(四分位距为9.6-15.1)。49例(57%)患者使用回肠进行膀胱增容,32例(37.2%)使用西格玛,5例(5.8%)使用输尿管。27例患者在同一手术中植入了人工尿道括约肌(AUS)。术前平均膀胱容量为 117 毫升(标清 40),术后一年增加到 430 毫升(标清 64),这一差异具有统计学意义(PConclusions:这项研究的长期结果表明,对于药物治疗无效的神经性膀胱患者,AC 是一种有效的手术治疗方法。膀胱增容术后长期存在并发症风险,因此对这些患者进行密切的临床随访至关重要。
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来源期刊
Minerva Urology and Nephrology
Minerva Urology and Nephrology UROLOGY & NEPHROLOGY-
CiteScore
8.50
自引率
32.70%
发文量
237
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