| [Objective] Neurogenic bladder is a class of diseases which lost control of urinary function and the incidence is higher in pediatric surgery. Because of the bladder or urethra dysfunction led by the central or peripheral nervous system, patients had difficulty urinating. The most important cause here is congenital dysplasia of spinal cord, including spina bifida, fat meningocele, sacral dysplasia, diastematomyelia, enteric cysts. Neurogenic bladder can also be caused by the pelvic nerve injury or surgery sacrococcygeal teratoma. The treatment of neurogenic bladder has not yet researched a standard consensus and the patients are in need of comprehensive treatment. In view of the failed conservative treatment, the poor effect and the low bladder capacity of children, most scholars now prefer to select bladder augmentation. This surgery can improve bladder function as a low-pressure container in order to protect the kidneys and to complete control of urination. Because of the different conditions and different operation methods, the curative effect and the incidence of short and long term complications differ as well. To evaluate the long-time therapeutic effect of an ileum muscular layer patch containing neurovascular pedicle with neurogenic bladder, we now make a long-time follow-up to assess the long-term effects of this surgery and complications after bladder augmentation in children with neurogenic bladders.[Methods] A total of 32 children with neurogenical bladder underwent bladder augmentation using a demucosalized ileoseromuscular layer patch containing neurovascular pedicle (23 males and 9 females).8 cases had ureterohydronephrosis and/or 3 had vesicoureteral reflux (VUR) and 26 cases had pelvic muscle relaxation. We made a 5-12a follow-up researchment and the therapeutic effects were evaluated by means of the International Advisory Committee Incontinence Questionnaire Short Form (ICI-Q-SF), combined with the urodynamic examination, ultrasonic examination and cystoradiography. All cases were followed at regular intervals with serum electrolytes, renal function and ultrasonic examination. The complications were monitored. [Results] During the follow-up 26 patients (81.25%) were improved or cured referring to clinical symptoms, but 6 patients (18.75%) without significant improvement. Before and after surgery the ICI-Q-SF questionnaire scores were (18.1±1.0) points and (7.8±2.5) points. Statistical analysis showed that t test was 14.688 and P was less than 0.000. So the difference was statistically significant. The average preoperative urodynamic bladder maximum capacity was (0.134±0.058) L, the bladder compliance was (0.037±0.014) L·kPa-1 and the filling the detrusor (4.861±2.283) kPa. Postoperative maximum bladder capacity, bladder compliance, were improved significantly increased, respectively (0.257±0.054) L, (0.103±0.032) L·kPa-1. The bladder pressure at filling end phase was (2.401±0.794) kPa and decreased compared with that before. Postoperative electrolyte and renal functions were normal. Two cases of vesicoureteral reflux were cured and one case made no change. After retrograde cystography,26 cases with preoperative pelvic floor muscle relaxation showed that the bilateral bladder neck was higher than the obturator connection. And there were 5 cases long term complications:4 cases of symptomatic urinary tract infection,1 case of bladder stones.[Conclusion] Bladder augmentation using a demucosalized ileoseromuscular layer patch containing neurovascular pedicle has showed low complication rate and long-time effect. All patients should be regular follow-up after operations, especially for children with poor postoperative outcome, in time to take other treatments. |
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