Analysis Of Augmentation Cystoplasty Combined With Ureter Reimplantation In Children With Neurogenic Bladder

Background and purposeNeurogenic bladder(NB)is a bladder urethral dysfunction caused by nervous system diseases or post-traumatic injuries.It is characterized by abnormal bladder urine storage and micturition,which leads to renal failure caused by bladder trabecular hyperplasia and hypertrophy,vesicoureteral reflux(VUR),chronic urinary tract infection or deterioration of upper urinary tract.Urinary incontinence and vesicoureteral reflux are one of the most common complications of NB.Urinary incontinence seriously affects the quality of life and physical and mental health of children.Vesicoureteral reflux can lead to progressive renal damage.Even if long-term preventive application of antibiotics and clean intermittent catheterization,there is always a risk of urinary tract infection and upper urinary tract injury.Augmentation cystoplasty(AC)is the most commonly used surgical method to improve bladder function.There is controversy about whether children with NB with VUR should undergo anti-reflux surgery at the same time:some researchers believe that AC alone can increase bladder capacity and reduce bladder pressure,which is enough to alleviate ureteral reflux exist before operation;Some studies have also reported the high residual rate of VUR after AC alone,especially high-grade reflux.It is sugested that ureteral anti-reflux surgery should be performed simultaneously with bladder dilatation in children with NB with VUR.This study mainly combined with the experience of our center to explore the therapeutic value of bladder augmentation combined with ureteral reimplantation in children with NB with vesicoureteral reflux.MethodsThe clinical data of 36 children with neurogenic bladder and vesicoureteral reflux diagnosed by pediatric surgery of the First Affiliated Hospital of Zhengzhou University from January 2014 to August 2020 were analyzed retrospectively;They were divided into augmentation cystoplasty group(group A,22 cases,33 ureters)and augmentation cystoplasty combined with ureter reimplantation group(group B,14 cases,18 ureters);There was no significant difference in age,gender,grade of vesicoureteral reflux,past history and clinical symptoms between the two groups(P>0.05);The operation time,intraoperative blood loss and postoperative hospital stay were compared between the two groups;The changes of bladder volume,bladder compliance,maximum detrusor pressure,residual rate of ureteral reflux,urinary tract infection rate and distal ureteral diameter ratio were compared between the two groups before and after operation.ResultsThe operation was successful in all children.There were significant differences in the operation time[(152.6±24.4)min and(232.4±44.9)min]and the residual rate of postoperative ureteral reflux(57.58%vs 16.67%)between group A and B(P<0.05).There was no significant difference in intraoperative blood loss[(19.8±4.8)ml and(21.1±5.3)ml],postoperative hospital stay[(30.2±6.5)d and(29.6±5.1)d],and the rate of recurrent febrile urinary tract infection(22.73%vs 14.29%)(P>0.05);Although there was no significant difference in the ratio of distal ureter diameter between the two groups before and after operation(P>0.05),the difference between the two groups before and after operation was statistically significant(Z=3.01,P=0.003);There were significant differences in bladder volume,bladder compliance and maximum detrusor pressure between the two groups(P<0.001).The patients were followed up for 12 to 36 months.One case of bladder fistula occurred in both groups and recovered after indwelling urinary catheter;In group A,I case was cured after ureter reimplantation due to continuous bilateral vesicoureteral reflux and recurrent febrile urinary tract infection;One case in group B was cured after abdominal exploration due to peritonitis,and there was no obstruction of ureter bladder junction.ConclusionFor children with neurogenic bladder with vesicoureteral reflux,augmentation cystoplasty combined with ureter reimplantation is safe and effective.Compared with simple bladder dilatation,increasing bladder capacity,reducing bladder detrusor pressure and improving bladder compliance while reducing the residual rate of postoperative ureteral reflux,distal ureter diameter ratio did not increase the rate of postoperative urinary tract infection,length of hospital stay and intraoperative blood loss.