神经源性膀胱扩大术远期疗效观察

目的 评价保留膀胱黏膜的双层肠管浆肌层膀胱扩大术的远期疗效.方法 病例选择条件:术前有明确支配膀胱的神经性损害,膀胱容量明显小于同龄儿童的正常值,同时伴有Ⅳ度以上膀胱输尿管反流,经过一段时间的口服抗胆碱能药物、清洁间歇导尿等保守治疗后,膀胱内压仍然较高,输尿管反流无明显改善,我们对符合上述条件的75例神经源性膀胱患儿行切除部分逼尿肌保留膀胱黏膜的双层肠浆肌层膀胱扩大术,同时根据患儿的具体情况选择性联合应用膀胱输尿管移植抗反流、膀胱颈紧缩、膀胱颈悬吊等手术方式,术后对患儿进行长期随访,对手术前后临床症状、肾脏功能、尿流动力学(膀胱容量、残余尿、逼尿肌压和顺应性)等方面进行评价.结果 75例手术患儿中68例获得随访,随访时间平均4.3年,术后无一例发生肾脏功能衰竭,45例获得一定的临床治疗改善.23例术后在尿流动力学、临床症状方面无明显改善.结论 术后膀胱容量不能有效扩大是导致术后疗效不理想的重要原因,保留膀胱黏膜的双层肠浆肌层膀胱扩大术是治疗神经源性膀胱的一种方法,但该方法有待改进.     

Extrophy of the urinary bladder

Extrophy of the urinary bladder is a rare congenital anomaly first described in ancient times, and which C.H. Mayo (1919) called "the most serious and troublesome of all human defects to contend with". The condition occurs once in every 30,000 or 40,000 live births, and is more common in males than females. It poses a challenging and fascinating problem in management for the surgeon and has accumulated an extensive literature. The purpose of this paper is to present a brief review of the disorder with emphasis upon treatment.     

Rhabdomyosarcoma of the urinary bladder

Summary Rhabdomyosarcoma of the urinary bladder in a 1 1/2-year-old female infant is reported. It presented as a mass in the abdomen, with total absence of urinary symptoms. The symptomatology and management of the case are briefly discussed. From the Kalawati Saran Children's Hospital, New Delhi 10 0001.     

The role of estrogens in the pathogenesis of bladder dysfunction of the hyperreflexia type and vesico-ureteral reflux in children

Patients with the uninhibited urinary bladder of the hyperreflexia type and the vesicoureteral reflux were subjected to multimodality examinations which included excretory urography, retrograde cystometry, cystography, profilometry of the ureterovesical anastomosis, cytologic investigation of estrogenic saturation, determination of the concentration of follicle-stimulating hormone of the pituitary and estradiol by means of radioimmunoassay. As many as 56 girls aged 4 to 15 years underwent examination. It has been demonstrated that dysfunction of the urinary bladder of the hyperreflexia type is of crucial role as an active mechanism of extra-vesicalization of the intra-vesical part of the ureter, associated with its antireflux function distress.     

Replacement of the urinary bladder with rectum

The rectum can be used as a substitute for the urinary bladder such that the normal outlet for feces at the anus is left undisturbed and continent. Perfect and complete continence is achieved by creating a narrow neck of the rectal bladder with a sphincter around it and a narrow urinary outlet, a neourethra, also with a sphincter around it. Three different types of anomaly necessitating reconstruction of the urinary bladder were operated upon by this procedure. Three patients are doing well in respect to micturition and defacation, having achieved total continence for both.     

Vesicoureteral reflux in the primate: III. Effect of urinary tract infection on maturation of the ureterovesical junction.

Recurrent bladder infections in the monkey appeared to cause a delay in maturation of the ureterovesical junction. This was not significant since it did not ultimately prevent maturation. Bacteriuria was prolonged when reflux was present.     

Exophytic urinary bladder lesions in childhood

A retrospective study of the clinical presentation, diagnosis, and treatment of eight patients whose common characteristic was an exophytic, solid urinary bladder lesion (botryoid rhabdomyosarcoma, transitional-cell carcinoma, nephrogenic adenoma, cystitis cystica, von Brunn's nests, hemangioma, and squamous-cell metaplasia) is presented. Exophytic bladder lesions, some of which are of great importance, are rare entities in childhood and present nonspecific clinical pictures. Therefore, whenever a space-occupying lesion is detected on a complementary study of the lower urinary tract, the differential diagnosis should be considered. Advantages of each of the currently available diagnostic methods are discussed and the essential role of cystoscopy is stressed.     

Bladder-neck repair in urinary bladder exstrophy

A simple modification of an existing technique for bladder-neck reconstruction in exstrophy of the urinary bladder is reported. The technique involves tubularization of the posterior urethra up to just below the ureteric orifices. It differs from other techniques in that no part of the bladder tissue is used for buttressing the repair, but all is utilized for enhancing the bladder volume. Only 2 of 20 patients remained incontinent after bladder-neck reconstruction; the remaining 18 have achieved socially acceptable continence. Accepted: 17 June 1998     

Leech in urinary bladder causing hematuria

ObjectiveTo estimate efficacy of normal saline in the management of hematuria caused by accidental entry of a leech per urethra into the urinary bladder.MethodsAn intervention study was carried out in the Department of Pediatric Surgery of Sylhet MAG Osmani Medical College between January 1998 and December 2003. A total of 43 boys (mean age 8 years, SD ± 2.6) were enrolled. In all cases, a leech had entered the urinary bladder through the urethra causing hematuria. All patients were equipped with a self-retaining Foley catheter. They were managed by infusing 50 ml of normal saline into the urinary bladder through the catheter that was then clamped for 3 h.ResultsAfter removing the catheter, in all cases the whole leech was spontaneously expelled intact, dead or alive, within 2–24 h during the subsequent act of micturition. Hematuria gradually diminished to a clear flow within the next 6 h in 27 cases, 12 h in 14 cases and 24 h in two cases. All patients were followed up for 2 weeks, and none developed recurrent hematuria.ConclusionCatheterization and irrigation of the urinary bladder with normal saline is a relatively simple, safe and inexpensive method of removing the leech and controlling hematuria.     

Eosinophilic gastroenteritis with involvement of the urinary bladder

Eosinophilic gastroenteritis with eosinophilic infiltration of the urinary bladder wall is rare in children. We describe the CT findings of eosinophilic gastroenteritis accompanied by bladder involvement in an 11-year-old boy. CT imaging showed diffuse wall thickening of the entire gastrointestinal tract from the esophagus to the colon and revealed a halo sign, irregular fold thickening and luminal narrowing without obstruction of the gastrointestinal wall. Another CT finding was the diffuse thickening of the bladder wall with moderate enhancement on postcontrast CT. The boy underwent endoscopic biopsy from various sites of the gut wall and histology revealed increased eosinophiliac infiltration in the mucosa. After corticosteroid therapy, the boy recovered gradually. The case emphasizes that not only the gastrointestinal tract but also the urinary bladder may be involved in children with eosinophilic gastroenteritis and that recognition of CT features of this disease aids in early diagnosis and therapy.