Analysis Of Two Different Bladder Augmentation Cystoplasty Of22Cases For Treatment Of Neurogenic Bladder

Background and objective:Neurogenic bladder dysfunction (NBD) refers to some kind of reason caused bladder urethra dysfunction, such as neuropathy, or damage that dominates the urinary tract namely urine storage and micturition dysfunction. For those children that force durinous muscle fiber in bladder, bladder capacity after conservative treatment can not improve, the upper tract function damage, need surgery. Current the main method of surgical treatment is bladder augmentation cystoplasty. There is many different kinds of cystoplasty and each has advantages and disadvantages. Based on the follow-up study, evaluates clinical curative effects of the ileum augmentation cystoplasty and ileum pulp muscularis augmentation cystoplasty, looks for better way of operation,and reduces postoperative complications.Methods:Collects the22cases of neurogenic bladder, urethra dysfunction of children treated in the second hospital of shan dong university in July2005to May2012for follow-up research. All children have done detailed history records before the surgery, clinical manifestations, surgical history and micturition circumstance. B-ultrasound, intravenous pyelogram(IVP), voiding cystourethrogram (VCUG) and urodynamics were done before operation, twelve patients underwent the ileum augmentation cystoplasty, and ten patients underwent ileum pulp muscularis augmentation cystoplasty. Retrospective analysis those clinical data of the two different augmentation cystoplastys,compare the two kinds of surgical operation method, clinical manifestations before and after surgery, bladder capacity compliance, detrusor pressure and urodynamics, evaluate objectively the effect of two kinds of surgical procedures.Result:1. General information:Twelve patients underwent the ileum augmentation cystoplasty(male3, female9, male to female ratio is1:3); Ten patients underwent ileum pulp muscularis augmentation cystoplasty (male10, female5, male to female ratio of1:1), The age of patients range from3to19years old,average11.0years old.We obtained those information from medical records and the clinic diagnosis and treatment records,22patients received follow-up.These patients followed up for4months to53months, an average of19.5months. Spinal meningocele finished repair was15cases, Tethered cord syndrome released after operation was7cases.2.The result of urodynamics:The capacity of the two operation procedures of the ileum augmentation cystoplasty and ileum pulp muscularis augmentation cystoplasty are all increase, respectively (171.75+91.16) vs (306.67+130.54) ml,(173.00+149.75) vs (197.90+120.31) ml (P<0.05), bladder capacity difference before and after operation respectively,(144.58+130.44) ml,(32.50-)32.50ml; At the end of the full bladder detrusor pressure before and after operation, respectively (43.00+21.12) vs (21.42+11.87) cm H2O,(59.00-25.34) VCS (44.80+20.24) cm H2O,;The difference of at the end of the full bladder detrusor before and after operation, respectively (21.58+21.32) cm H2O,(15.20-25.65) cm H2O. The contraction without inhibit in patients underwent the ileum augmentation cystoplasty4cases visible,2cases visible when coughing,6cases were not seen; The ileum pulp muscularis augmentation cystoplasty:5cases visible,4cases visible when coughing,1case was not seen. Both types of surgery compliance are improved compared with the previous, the ileum augmentation cystoplasty was75%, the ileum pulp muscularis augmentation cystoplasty at60%.3. The clinical manifestations:Before operation:All children almost have a dribbling, wet pants, no bubble urine, perineal moisture, hypesthesia or feel free when urinating. Postoperative follow-up results:Symptoms of urinary incontinence in the patients after the both bladder augmentation cystoplasty were significantly improved, the patient of the ileum augmentation cystoplasty had1case (8.3%) had symptoms of urinary tract infection,1case (8.3%) appeared bladder calculi and improved after the symptomatic treatment。The patient of ileum pulp muscularis augmentation cystoplasty had1case (10%) in children with symptoms of urinary incontinence, and improved after tolterodine.4. statistical analysisThe results of urodynamic test before and after operation, respectively, uses SPSS17.0software for statistical analysis, data results uses mean+/-standard deviation。Firstly, with the change of the paired t test evaluates before and after surgery, then with Wilcoxon rank test evaluaes two kinds of the change of the difference before and after operation, with P<0.05was statistically significant.Conclusion:1.Children with neurogenic bladder due to lower bladder compliance, decreased capacity, increased bladder pressure, most of them have urinary incontinence, wet pants, dribbling, little bubble urine, wetting the bed at night, etc.These sympotoms not only affect the children’s life and health of body and mind,but can endanger patients’ life,.Through the follow-up study found that bladder augmentation cystoplasty can obviously improve the symptoms above-mentioned.2. Through the results of urodynamics can see that the ileum augmentation cystoplasty is superior to ileum pulp muscularis augmentation cystoplasty in increasing bladder capacity and reducing filling at the end of the detrusor pressure and improve detrusor contraction without inhibitation.Therefore these patients with neurogenic bladder whose bladder with evere fibrosis contracture, capacity significantly reduced, and detrusor hyperreflexia can perform the ileum augmentation cystoplasty.3. Compared to ileum pulp muscularis augmentation cystoplasty, the operation technique of ileum augmentation cystoplasty is simple, not easy to damage muscular loops, etc.