使用和废弃可导尿的通道作为排空神经性膀胱的主要方法:一项单一机构队列研究。

IF 5.9 2区 医学 Q1 UROLOGY & NEPHROLOGY Journal of Urology Pub Date : 2024-11-04 DOI:10.1097/JU.0000000000004313
Yifan Meng Griffin, Rosalia Misseri, Joshua D Roth, Benjamin M Whittam, Pankaj Dangle, Shelly King, Kirstan K Meldrum, Martin Kaefer, Mark P Cain, Richard C Rink, Konrad M Szymanski
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Channels were created at a median age of 8 years (median follow-up: 11 years, 78% self-catheterized). Overall, 76 people disused their channels. The most common reasons for disuse were nonmechanical (64%). After disuse, 46% underwent incontinent diversion. After correcting for differential follow-up, 89% of people still used their channels at 10 years and 81% at 20 years. When analyzing all disused channels in patients reaching adulthood on multivariable analysis, channels catheterized by others had 3.78 times the risk of disuse compared with self-catheterized channels (<i>P</i> < .001); RLQ channels were 1.06 times more likely to be disused than umbilical channels (<i>P</i> = .02). For channels disused for nonmechanical reasons, catheterization by others, not attending transition clinic, and RLQ stoma were independently associated with disuse (<i>P</i> ≤ .04). 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引用次数: 0

摘要

目的:我们旨在评估可持续导尿的尿道(CCC)的长期使用情况,并探讨其废弃的潜在风险因素:我们对在本院接受阑尾造口术和蒙蒂手术的患者进行了回顾性研究(1991-2023 年)。主要结果是CCC失用(不将间歇性导尿通道作为排空膀胱的主要方法)。结果561人(46%为男性,57%为分流患者,72%为脊柱裂患者)符合纳入标准(244人为阑尾造口术患者,317人为蒙蒂患者;69%为右下腹[RLQ]患者)。建立管道的年龄中位数为 8 岁(随访时间中位数:11 年,78% 的患者自行导尿)。总共有 76 人停用了管道。最常见的停用原因是非机械性的(64%)。在校正随访差异后,分别有 89% 和 81% 的人在 10 年和 20 年后仍在使用导尿管。在对成年患者的所有废弃导尿管进行多变量分析后发现,与自行导尿管相比,由他人导尿的患者废弃导尿管的风险是自行导尿的患者的3.78倍(p结论:大多数CCC患者都会使用导尿管:在长期随访中,大多数人都使用 CCC。1%的人每年都会停止使用。从未自行导尿、从未去过过渡诊所或拥有 RLQ 造口的人停用导尿管的风险较高,尤其是由于非机械原因。
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Use and Disuse of Catheterizable Channels as the Primary Method of Emptying the Neuropathic Bladder: A Single Institutional Cohort Study.

Purpose: We aimed to assess long-term use of continent catheterizable urinary channels (CCCs) and explore potential risk factors of disuse.

Materials and methods: People undergoing appendicovesicostomy and Monti procedures at our institution were retrospectively reviewed (1991-2023). The main outcome was CCC disuse (not intermittently catheterizing channels as the primary method of bladder emptying). Cox regression was used.

Results: Five hundred sixty-one people (46% male, 57% shunted, 72% spina bifida) met inclusion criteria (244 appendicovesicostomy, 317 Monti; 69% right lower quadrant [RLQ]). Channels were created at a median age of 8 years (median follow-up: 11 years, 78% self-catheterized). Overall, 76 people disused their channels. The most common reasons for disuse were nonmechanical (64%). After disuse, 46% underwent incontinent diversion. After correcting for differential follow-up, 89% of people still used their channels at 10 years and 81% at 20 years. When analyzing all disused channels in patients reaching adulthood on multivariable analysis, channels catheterized by others had 3.78 times the risk of disuse compared with self-catheterized channels (P < .001); RLQ channels were 1.06 times more likely to be disused than umbilical channels (P = .02). For channels disused for nonmechanical reasons, catheterization by others, not attending transition clinic, and RLQ stoma were independently associated with disuse (P ≤ .04). No variables were associated with disuse for mechanical reasons (P ≥ .22).

Conclusions: Most people with CCCs use them on long-term follow-up. One percent stopped using them annually. People who never self-catheterized, never attended transition clinic, or never had RLQ stomas were at higher risk of channel disuse, particularly because of nonmechanical reasons.

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来源期刊
Journal of Urology
Journal of Urology 医学-泌尿学与肾脏学
CiteScore
11.50
自引率
7.60%
发文量
3746
审稿时长
2-3 weeks
期刊介绍: The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide, and practice-oriented reports on significant clinical observations.
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