BACKGROUND Augmentation cystoplasty is indispensable in many pediatric diseases,especially neurogenic bladder.Various methods and materials are used to augment the bladder,and these methods are associated with differe...BACKGROUND Augmentation cystoplasty is indispensable in many pediatric diseases,especially neurogenic bladder.Various methods and materials are used to augment the bladder,and these methods are associated with different shortcomings and complications.AIM The present study reported the mid-term outcomes of patients undergoing various bladder augmentation procedures in a single institution,and assessed whether seromuscular cystoplasty lined with urothelium(SCLU)provided better urodynamic results than auto-augmentation(AA).METHODS A retrospective review of 96 patients undergoing various augmentation methods between 2003 and 2018 was performed.The patients were divided into three groups according to the type of augmentation,and their outcomes were compared.All patients developed neurogenic bladder due to myelomeningocele or sacrococcygeal teratoma.The clinical data of all patients were collected.RESULTS The mean ages at surgery in the three groups(standard cystoplasty[SC],SCLU,AA)were 10.8,7.5,and 4.8 years,respectively,with mean follow-ups of 36,61,and 36 mo,respectively.The mean preoperative and postoperative bladder capacities of the SC,SCLU,and AA groups were 174±11.7 vs.387±13.7(P<0.0001),165±12.2 vs.240±14.7(P=0.0002),and 138±16.7 vs.181±9.9(P=0.0360),respectively.Compared with the AA group,the SCLU procedure did not have better postoperative urodynamic parameters.Incontinence was reduced in most patients.The mean times of clean intermittent catheterization per day in the SC,SCLU,and AA groups were 5.6,7.8,and 8.2,respectively.The main complications of the SC group were recurrent urinary tract infections(8%)and bladder calculi(6%).Re-augmentation was done in patients in the SCLU(8)and AA(3)groups.CONCLUSION SC provided sufficient bladder capacity and improved compliance with acceptable complications.After AA and SCLU,the patients acquired limited increases in bladder capacity and compliance with a high rate of re-augmentation.Compared with AA,SCLU did not yield better postoperative urodynamic parameters.展开更多
BACKGROUND Intestinal seromuscular bladder augmentation(SMBA)surgery has produced no mucosal-related complications,but its outcomes need to be studied.AIM To evaluate the safety and effectiveness of SMBA in the treatm...BACKGROUND Intestinal seromuscular bladder augmentation(SMBA)surgery has produced no mucosal-related complications,but its outcomes need to be studied.AIM To evaluate the safety and effectiveness of SMBA in the treatment of children with neurogenic bladder.METHODS A retrospective analysis of the clinical data of children with SMBA was performed from March 2008 to February 2018,and the data were compared with those of children receiving standard cystoplasty(SC).RESULTS In a cohort of 67 children who underwent bladder augmentation,the 46 children in the SC group had an average age of 10.6 years and a follow-up time of 36 mo,and the 21 children in the SMBA group had an average age of 7.6 years and a follow-up time of 29.7 mo.The preoperative and postoperative bladder volumes in the SMBA group were 151.7 mL and 200.4 mL,respectively,and those in the SC group were 173.9 mL and 387.0 mL,respectively.No significant difference in preoperative urinary dynamic parameters was found between the two groups,but the difference after operation was statistically significant.The main complications after SMBA were residual ureteral reflux and failed bladder augmentation,with incidences of 33.3%and 28.6%,respectively.In all 6 patients with failed augmentation in the SMBA group,ileum seromuscular patches were used for augmentation,and SC was chosen for reaugmentation.During reoperation,patch contracture and fibrosis were observed.CONCLUSION The improvement of urinary dynamic parameters in the SMBA group was significantly lower than that in the SC group.Children with SMBA had a higher probability of patch contracture and reaugmentation,which might be related to impaired blood supply and urine stimulation,and the sigmoid colon patch should be the priority.展开更多
文摘BACKGROUND Augmentation cystoplasty is indispensable in many pediatric diseases,especially neurogenic bladder.Various methods and materials are used to augment the bladder,and these methods are associated with different shortcomings and complications.AIM The present study reported the mid-term outcomes of patients undergoing various bladder augmentation procedures in a single institution,and assessed whether seromuscular cystoplasty lined with urothelium(SCLU)provided better urodynamic results than auto-augmentation(AA).METHODS A retrospective review of 96 patients undergoing various augmentation methods between 2003 and 2018 was performed.The patients were divided into three groups according to the type of augmentation,and their outcomes were compared.All patients developed neurogenic bladder due to myelomeningocele or sacrococcygeal teratoma.The clinical data of all patients were collected.RESULTS The mean ages at surgery in the three groups(standard cystoplasty[SC],SCLU,AA)were 10.8,7.5,and 4.8 years,respectively,with mean follow-ups of 36,61,and 36 mo,respectively.The mean preoperative and postoperative bladder capacities of the SC,SCLU,and AA groups were 174±11.7 vs.387±13.7(P<0.0001),165±12.2 vs.240±14.7(P=0.0002),and 138±16.7 vs.181±9.9(P=0.0360),respectively.Compared with the AA group,the SCLU procedure did not have better postoperative urodynamic parameters.Incontinence was reduced in most patients.The mean times of clean intermittent catheterization per day in the SC,SCLU,and AA groups were 5.6,7.8,and 8.2,respectively.The main complications of the SC group were recurrent urinary tract infections(8%)and bladder calculi(6%).Re-augmentation was done in patients in the SCLU(8)and AA(3)groups.CONCLUSION SC provided sufficient bladder capacity and improved compliance with acceptable complications.After AA and SCLU,the patients acquired limited increases in bladder capacity and compliance with a high rate of re-augmentation.Compared with AA,SCLU did not yield better postoperative urodynamic parameters.
文摘BACKGROUND Intestinal seromuscular bladder augmentation(SMBA)surgery has produced no mucosal-related complications,but its outcomes need to be studied.AIM To evaluate the safety and effectiveness of SMBA in the treatment of children with neurogenic bladder.METHODS A retrospective analysis of the clinical data of children with SMBA was performed from March 2008 to February 2018,and the data were compared with those of children receiving standard cystoplasty(SC).RESULTS In a cohort of 67 children who underwent bladder augmentation,the 46 children in the SC group had an average age of 10.6 years and a follow-up time of 36 mo,and the 21 children in the SMBA group had an average age of 7.6 years and a follow-up time of 29.7 mo.The preoperative and postoperative bladder volumes in the SMBA group were 151.7 mL and 200.4 mL,respectively,and those in the SC group were 173.9 mL and 387.0 mL,respectively.No significant difference in preoperative urinary dynamic parameters was found between the two groups,but the difference after operation was statistically significant.The main complications after SMBA were residual ureteral reflux and failed bladder augmentation,with incidences of 33.3%and 28.6%,respectively.In all 6 patients with failed augmentation in the SMBA group,ileum seromuscular patches were used for augmentation,and SC was chosen for reaugmentation.During reoperation,patch contracture and fibrosis were observed.CONCLUSION The improvement of urinary dynamic parameters in the SMBA group was significantly lower than that in the SC group.Children with SMBA had a higher probability of patch contracture and reaugmentation,which might be related to impaired blood supply and urine stimulation,and the sigmoid colon patch should be the priority.
