Efficacy and safety of continent anal urinary diversion for complicated bladder exstrophy in children by using modified Duhamel's procedure

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• 作者：Mohamed A. Baky Fahmy<sup>asup><sup> ; sup><sup>mabfahmy@hotmail.com" class="auth_mail" title="E-mail the corresponding authorsup> ; Alae A. Al Shenawy<sup>bsup> ; Sameh M. Shehata<sup>csup>
• 关键词：Duhamel's pull-through ; Bladder exstrophy ; Urinary diversion
• 刊名：Journal of Pediatric Urology
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：11
• 期：5
• 页码：254.e1-254.e6
• 全文大小：539 K

文摘

A high proportion of children with bladder exstrophy will continue to suffer from urinary incontinence and a miserable life even after a well-performed staged reconstruction in specialized centers. Most of those children usually have a normal anal sphincter allowing construction of a neobladder from the rectum, so they are continent without an abdominal stoma, and do not require frequent catheterization, which greatly contribute to a favorable body image.

sSec_2">Objective

spara0015">In this study a modified Duhamel's rectal pouch done for 19 children, with implication of suitable stapler adopted to construct a rectal bladder with a non-refluxing urterorectostomy, there is a theoretical advantage in our procedure of avoiding a mix of urine and feces.

spara0020">All patients were followed for up to 6 years (2&ndash;8 years) for efficacy, safety, subsequent renal complications, and surveillance for any rectal neoplastic changes in this new diversion.

sSec_3">Study design

spara0025">Assessment of electrolytes, acid base balance, and renal function were carried out regularly and all data were analyzed using the SPSS 9.0.1 statistical package and compared using a paired t test; data were considered significant if p < 0.05. Proctoscopy was performed 6 monthly in the first year then annually thereafter, and at any time if there was any rectal bleeding.

sSec_4">Results

spara0030">In this group of patients, follow-up revealed no neoplastic changes in the rectal bladder, deterioration in renal function, or major electrolytes disturbance. They can hold up to 400 mL (350&ndash;550 mL) of urine and all are continent during the daytime with an emptying frequency of 3&ndash;5 h; three patients had infrequent (4 episodes/month) nocturnal enuresis; and four cases developed pyelonephritis controlled with medical treatment.

sSec_5">Conclusion

spara0035">The continent rectal bladder created by using the principles of the Duhamel pull-through is feasible, easy to perform, successful in the immediate short term with low complications after 6 years of follow-up and appropriately accepted by the children and their families with marked improvement in quality of life regarding continence; longer-term follow-up is requested to rule out rectal neoplastic changes. A comparative review of the complications, patient's acceptance, and longer-term follow-up with other well-known procedures, such as Mainz II, is required.