Analysis Of The Effect Of Ileum Pulp Muscularis Augmentation Cystoplasty In Children With Neurogenic Bladder

BackgroundNeurogenic bladder is caused by a variety of reasons control the function of urination central or peripheral nerve damage caused by bladder detrusor and/or urethral sphincter dysfunction,the production of urine storage and urination dysfunction.It is an important disease in the field of pediatric urology.The main causes are congenital diseases,including meningocele,myelomeningocele,diastemyelia,tethered cord syndrome,and sacral insufficiency.Neurological tumors,pelvic surgery,trauma and other spinal cord injuries can also cause neurogenic bladder in children.There are different clinical manifestations and various types,so there is no fixed and unified treatment method for the treatment at present.Individualized treatment plans should be developed according to the specific conditions of children.In children with neurogenic bladder,timely surgical treatment is required when the conservative treatment effect of drugs,clean intermittent catheterization and other treatments is poor or serious complications occur.augmentation cystoplasty is currently the gold standard surgical procedure used to increase bladder capacity and reduce storage pressures during the urination storage period.There are various surgical methods for augmentation cystoplasty,including self-augmentation cystoplasty,uretero augmentation cystoplasty,ileum pulp muscularis augmentation cystoplasty,and whole-layer digestive tract augmentation cystoplasty.Each surgical method has its own advantages and disadvantages.In recent years,our hospital has adopted ileum pulp muscularis augmentation cystoplasty,which can significantly increase bladder volume,increase bladder compliance and reduce bladder internal pressure.However,postoperative complications such as metabolic disorders,urinary stones,bladder perforation,and bladder cancer are also potential risks.Therefore,postoperative children should be followed up for a long time,so as to detect and deal with the above complications as early as possible,monitor the condition changes of children,and formulate reasonable treatment plans.ObjectiveThis study retrospectively analyzed 58 cases of children with neurogenic bladder admitted to our hospital.By comparing the clinical manifestations of urinary incontinence,maximum bladder volume and bladder compliance of the children before and after surgery,the surgical efficacy of ileum pulp muscularis augmentation cystoplasty was evaluated,and the incidence of postoperative complications was analyzed.In order to improve the children neurogenic bladder postoperative follow-up attention,improve the quality of life of children.MethodsThis study collected and analyzed the clinical data of 58 children with detrusor hyperreflexia neurogenic bladder treated by ileum pulp muscularis augmentation cystoplasty in our department from January 2013 to December 2018.Including clinical manifestations,routine urine tests,electrolytes,renal function and other laboratory tests,color doppler ultrasound,X-ray plain film,intravenous pyelography,excretory cystourethrography,urodynamic examination and other imaging examinations.After the completion of the preoperative examination,all the children underwent ileum pulp muscularis augmentation cystoplasty,and follow-up was 6months to 6 years.During each follow-up,the improvement of the clinical symptoms,such as urinary incontinence,was carefully inquired.Routine urine tests,electrolytes,renal function tests,color doppler ultrasonography of urinary system,retrograde cystography,and urodynamic examination were performed.The changes of clinical symptoms before and after operation were compared.Changes of urine routine,electrolyte and renal function;Changes of hydronephrosis with ureteral dilatation and bladder and ureteral reflux;Changes of urodynamic examination results,including maximum bladder volume and bladder compliance;And complications.ResultsPostoperative urine routine,electrolyte and renal function tests were all in normal range in 58 cases.The symptoms of incontinence disappeared completely in21 cases,improved significantly in 18 cases,improved slightly in 10 cases,and did not change significantly in 9 cases.Among the 46 cases of children with hydronephrosis before surgery,25 cases were still combined with hydronephrosis after surgery,and the degree of hydronephrosis and ureteral dilatation was significantly reduced in the children who were still combined with hydronephrosis after surgery.No new hydronephrosis was found in children without hydronephrosis before operation.Preoperative 31 cases combined with bladder and ureter regurgitation were still combined with bladder and ureter regurgitation in 15 cases,and the grade of regurgitation was reduced in different degrees compared with that before surgery.The maximum bladder volume and bladder compliance of the children in the preoperative urodynamic examination were:（137.17±31.95）ml、（6.10±2.25）ml/cmH₂O,Postoperative bladder volume was significantly increased and bladder compliance was increased,respectively:（233.02±60.51）ml、（12.90±2.81）ml/cmH₂O.Postoperative complications occurred in 12 of the 58 cases,including urinary tract infection in 7 cases,improved symptoms after antibiotic treatment,urinary tract calculi in 5 cases,external lithotripsy or bladder lithotomy was performed.No serious complications such as bladder perforation or bladder tumor were found.Conclusion1.Ileum pulp muscularis augmentation cystoplasty can significantly improve the clinical symptoms of urinary incontinence,increase bladder capacity,improve bladder compliance,and protect the function of the upper urinary tract.2.Children with neurogenic bladder should be followed up for a long time after surgery to find and deal with complications in time,monitor the condition changes of children,and formulate reasonable treatment plans.