Combined Bladder Neck Reconstruction and Continent Stoma Creation as a Suitable Alternative for Continence in Bladder Exstrophy: A Preliminary Report
| Autor: | John P. Gearhart, John Jayman, Karl Benz, Kathy Lue, Mahir Maruf, Matthew Kasprenski, Timothy Baumgartner |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Epispadias Adolescent Urology Urinary system Urinary Bladder 030232 urology & nephrology Stoma 03 medical and health sciences 0302 clinical medicine medicine Humans Child Retrospective Studies Urinary continence business.industry Bladder Exstrophy Surgical Stomas Perioperative Cloacal exstrophy medicine.disease Surgery Bladder exstrophy Neck of urinary bladder 030220 oncology & carcinogenesis Child Preschool Urologic Surgical Procedures Female business |
| Zdroj: | Urology. 119 |
| ISSN: | 1527-9995 |
| Popis: | Objective To explore the use of concomitant bladder neck reconstruction (BNR) and creation of a continent stoma (CS) in patients who are not quite eligible for BNR but still strongly desire volitional voiding. Methods The authors retrospectively reviewed an institutional database of patients with exstrophy-epispadias complex who underwent BNR-CS between 2000 and 2015. Indications for a BNR-CS, perioperative outcomes, and continence status were evaluated. Method of voiding and continence status were analyzed for patients with greater than 6 months of follow-up after the BNR-CS. Results A total of 24 patients with exstrophy-epispadias complex (15 male and 9 female) underwent BNR-CS at a median age of 8.9 years (range 5.4-17.4). This included 18 patients with classic bladder exstrophy, 5 with epispadias, and 1 with a cloacal exstrophy variant. There were 5 surgical complications (20.1%) following the BNR-CS, including 3 febrile urinary tract infections, 1 superficial wound infection, and 1 urethrocutaneous fistula. The median follow-up time from the time of BNR-CS was 1.1 years (range 0.1-14.1). Seventeen of 24 patients (71%) had a follow-up greater than 6 months and were evaluated for continence. Twelve patients (71%) were completely dry for intervals greater than 3 hours following BNR-CS. Five (29%) did not achieve continence with BNR-CS. Of those 5 patients, 3 (60%) underwent subsequent bladder neck transection. Conclusion Combined BNR and CS is a suitable alternative to achieve urinary continence in patients who are not ideal candidates for BNR alone. This approach can offer a select group of patients the opportunity for volitional voiding. |
| Databáze: | OpenAIRE |
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