保留膀胱黏膜肠浆肌层膀胱扩大术的尿流动力学评价

目的评价神经性膀胱行保留膀胱黏膜双层小肠浆肌层膀胱扩大术后的尿流动力学变化。方法45例逼尿肌反射亢进型神经性膀胱行保留膀胱黏膜的小肠浆肌层膀胱扩大术，男26例，女19例，年龄4～14岁。36例随访2年，手术前后行尿流动力学检查。结果手术后膀胱容量、膀胱顺应性、尿流率较术前增加，逼尿肌压降低，残余尿量／膀胱容量较术前减小，无抑制收缩减轻。逼尿肌括约肌不协调和尿道闭合压无改变。30例临床症状改善。结论保留膀胱黏膜的双层肠浆肌层膀胱扩大术可增加膀胱容量及顺应性，降低逼尿肌压，减轻逼尿肌反射亢进的程度，逼尿肌括约肌不协调以及尿道闭合压无明显变化。     

神经源性膀胱患儿回肠浆肌层膀胱扩大术后长期随访

目的 探讨回肠浆肌层膀胱扩大术治疗神经源性膀胱患儿的远期疗效.方法 应用回肠浆肌层膀胱扩大术治疗神经源性膀胱患儿32例.男23例,女9例;8例术前合并双肾输尿管积水及双侧输尿管扩张,3例单侧膀胱输尿管返流,2例有轻度肾功能损害.对比手术前后主观症状[国际尿失禁咨询委员会问卷简表(ICI-Q-SF问卷)]、尿流动力学检查、泌尿系超声及逆行膀胱造影,评价术后疗效.术后所有患儿定期复查血电解质、肾功能及泌尿系超声,监测并发症.结果 随访5～12 a,26例(81.25%)临床症状好转或痊愈,6例(18.75%)无明显改善.术前ICI-Q-SF问卷评分为(18.1±1.0)分,随访结束为(7.8±2.5)分,二者比较差异有统计学意义(t=14.688,P=0.000).尿流动力学检查显示术后最大膀胱容量、膀胱顺应性较术前明显增加,充盈末逼尿肌压较术前降低.术后电解质、肾功能均正常.远期并发症5例:4例并症状性泌尿系感染,1例并膀胱结石.结论 回肠浆肌层膀胱扩大术治疗神经源性膀胱患儿并发症少,远期疗效比较理想.     

神经性膀胱的评价和治疗

目的评价不同严重程度神经性膀胱患儿的治疗方法和结果。方法 2013年4月至2014年1月我们收治神经性膀胱患儿15例,男7例,女8例,年龄1~13岁,均有脊膜膨出修补术病史。全部患儿行尿动力学检查、泌尿系超声和排泄性膀胱尿道造影。尿动力学检查显示9例合并逼尿肌压升高,12例合并膀胱容量减少,7例合并逼尿肌过度活动;泌尿系超声和排泄性膀胱尿道造影显示8例合并肾积水和输尿管扩张,7例合并输尿管反流。5例行手术治疗,其中1例行小肠膀胱扩大及输尿管抗反流术,2例行逼尿肌部分切除膀胱扩大术及输尿管抗反流术,1例行小肠膀胱扩大术,1例行输尿管抗反流术,术后配合清洁间歇导尿。其余10例行清洁间歇导尿,4例同时口服索利那新。结果2例小肠膀胱扩大术后膀胱容量明显增加,逼尿肌压明显下降,输尿管反流消失;2例逼尿肌部分切除膀胱扩大术者膀胱容量略有增加,逼尿肌压略有下降,仍存在输尿管反流。1例输尿管抗反流者反流消失。保守治疗患儿中,膀胱容量在正常容量的2/3以上且逼尿肌压较低的6例患儿中,2例尿失禁消失,2例失禁较前明显减轻,2例无改善;膀胱容量不足正常1/2,逼尿肌压较高的4例患儿中,尿失禁及输尿管反流无明显减轻;4例应用索立那新后逼尿肌过度活动明显减轻。结论尿动力学检查泌尿系超声和排泄性膀胱尿道造影是评价神经性膀胱的重要手段,神经性膀胱患儿要根据其评价结果采取个性化的治疗方案。     

肠浆肌层膀胱扩大术治疗神经原性膀胱的临床应用

目的报告逼尿肌切开双层肠浆肌层膀胱扩大术治疗神经原性膀胱的临床应用.方法1986～1999年间治疗脊髓发育不良所致的反射亢进性神经原性膀胱52例(年龄4～18岁),通过随访比较手术前后临床表现和尿流动力学检查,评价其疗效.结果 43例随访3个月～13年,平均6.7年.术前均表现为尿失禁;术后均无粘液尿、电解质失衡、代谢紊乱、尿路结石等,24例(55.8%)能完全自主排尿,15例(34.9%)配合CIC可达到不失禁,有效率达到90.7%(39/43).39例手术前后行尿流动力学检查,其术前膀胱容量为(159±78)ml,膀胱容量差为(-145±67)ml,充盈期末逼尿肌压为(6.5±2.6)kPa;术后分别改变为(346±86)ml、(12±52)ml、(2.1±1.5)kPa.均较术前有显著改善(P<0.01),已达到或接近其正常范围.结论逼尿肌切开双层浆肌层膀胱扩大术是一种较理想的膀胱扩大术和反射亢进性神经性膀胱的有效疗法.     

改良Lich-Gregoir手术治疗神经性膀胱输尿管反流的评价

目的　探讨改良Lich Gregoir手术在治疗神经性膀胱输尿管反流中的应用。方法　神经性膀胱并输尿管反流患儿 12例 ,男 8例 ,女 4例 ,年龄 4～ 14岁 ,均为脊膜膨出修补术后。排泄性膀胱尿道造影 (VCUG)示膀胱输尿管反流左侧 5例 ,右侧 3例 ,双侧 4例 ,其中Ⅲ° 4条 ,Ⅳ° 10条 ,Ⅴ°2条。全部行改良Lich Gregoir输尿管抗反流术 ,同时行保留膀胱黏膜肠浆肌层膀胱扩大术。结果　术后 6个月随访 ,VCUG显示 16条反流的输尿管中 ,Ⅲ° 4条反流完全消失 ,Ⅳ°10条中 3条变为Ⅰ°,3条变为Ⅱ° ,1条变为Ⅲ°,3条无明显变化 ,Ⅴ°2条变为Ⅲ°。结论　神经性膀胱逼尿肌压增高 ,导致膀胱输尿管连接部功能失调 ,同时逼尿肌纤维化、膀胱挛缩 ,使得输尿管膀胱壁内段缩短 ,是输尿管反流的重要原因。行改良Lich Gregoir输尿管抗反流术的同时 ,须行膀胱扩大术 ,降低逼尿肌压 ,增加膀胱顺应性。     

神经性膀胱输尿管反流治疗对策的探讨

目的探讨神经性膀胱患儿输尿管反流的治疗措施。方法脊膜修补术后神经性膀胱并输尿管反流患儿45例,男29例,女16例,年龄4～14岁。排泄性膀胱尿道造影(VCUG)示膀胱输尿管反流左侧19例,右侧11例．双侧15例,其中Ⅰ°-Ⅲ°12例(15条),Ⅲ°-Ⅴ°33例(45条)。Ⅰ°-Ⅱ°中,5例(7条)仅行清洁间歇导尿,7例(8条)行保留膀胱黏膜肠浆肌层膀胱扩大术；Ⅲ°-Ⅴ°中,9例(12条)仅行间歇导尿。24例(33条)行保留膀胱黏膜肠浆肌层膀胱扩大术,其中19例(28条)同时行Lich-Gregoir手术,术后配合间歇导尿。结果6个月后随访,Ⅰ°-Ⅱ°15条中,7条行清洁间歇导尿,3条反流消失(42．9%),8条行保留膀胱黏膜肠浆肌层膀胱扩大术者,6条反流减轻或消失(75．0%)；Ⅲ°-Ⅴ°45条中,12条行间歇导尿者,10条反流程度进一步加重,5条单纯行膀胱扩大术者,2条反流减轻或消失(40．0%),28条同时行Lich-Gregoir手术者,23条反流减轻或消失(82．1%)。结论神经性膀胱输尿管反流的治疗方法取决于输尿管反流的程度。Ⅰ°-Ⅱ°单纯行膀胱扩大术,也可考虑只行清洁间歇导尿；Ⅲ°-Ⅴ°反流须在行膀胱扩大术的同时行输尿管抗反流术,术后配合间歇导尿。     

膀胱自体扩大术在神经性膀胱患儿中的应用评价

目的评价逼尿肌部分切除、膀胱自体扩大术的临床疗效。方法选择脊髓脊膜膨出患儿6例,其中男性3例,女性3例,年龄18个月至9岁。患儿均口服索利那新和行清洁间歇导尿3个月后无好转而行逼尿肌部分切除、膀胱自体扩大术,术后予清洁间歇导尿,手术前及术后1年行泌尿系超声、排泄性膀胱尿道造影,并行尿动力评价,评价指标为膀胱容量、膀胱顺应性和充盈末逼尿肌压。结果术前尿动力学检查显示6例患儿膀胱容量减小、膀胱顺应性下降及逼尿肌压升高,其中5例膀胱容量低于预期容量的50%。排泄性膀胱造影4例合并膀胱输尿管反流,其中左、右侧Ⅳ°反流各1例,双侧Ⅳ°反流2例。6例患儿手术后恢复顺利,无穿孔、感染发生。术后1年尿动力学检查显示6例患儿膀胱容量略有增加,但膀胱容量与预期膀胱容量(年龄×30+30)、膀胱顺应性及逼尿肌压力无明显变化,VCUG显示4例输尿管反流无减轻。结论对于膀胱容量明显变小的神经性膀胱患儿,逼尿肌部分切除、膀胱扩大术不能有效增加膀胱容量和顺应性,降低逼尿肌压,临床不能取得满意的效果。     

肛门直肠畸形术后排尿功能障碍的评价和治疗

目的 评价肛门直肠畸形术后排尿功能障碍的原因及治疗对策.方法 肛门直肠畸形术后患儿10例,男7例,女3例,年龄1～12岁.肛门闭锁直肠尿道球部瘘4例,肛门闭锁直肠尿道前列腺部瘘3例,泄殖腔畸形1例(共同管＜3 cm),肛门闭锁并球形结肠1例,肛门闭锁直肠前庭瘘1例.10例患儿均有排尿困难,其中3例伴有尿失禁.MRI显示2例合并脊髓栓系.排泄行膀胱尿道造影显示3例合并左侧输尿管Ⅳ°反流及肾积水,其中1例存在后尿道憩室,无1例发现尿道狭窄.尿动力学检查显示9例膀胱容量及残余尿增加,充盈期逼尿肌压正常,无逼尿肌过度活动,尿流率下降,其中8例逼尿肌收缩力下降,1例逼尿肌收缩力正常.另外1例直肠前庭瘘合并脊髓栓系患儿膀胱容量减少、残余尿增多、尿流率下降,充盈期逼尿肌压升高,合并逼尿肌过度活动.直肠尿道瘘合并后尿道憩室患儿行后矢状入路尿道憩室切除,泄殖腔畸形和直肠尿道前列腺部瘘术后合并输尿管反流患儿行左侧输尿管再植,8例合并神经性膀胱的患儿坚持清洁间歇导尿.结果 随访6个月～5年,泄殖腔畸形患儿1年后仍存在左侧输尿管反流及肾积水,直肠尿道球部瘘合并尿道憩室患儿输尿管反流及肾积水消失,无排尿困难及残余尿,直肠尿道前列腺部瘘合并左侧输尿管Ⅳ°反流及肾积水患儿输尿管反流消失,仍需间歇导尿,其余7例患儿无1例出现上尿路损害.结论 肛门直肠畸形合并脊髓发育不良及手术损伤可导致神经性膀胱.术中直肠尿道瘘处理不当可能导致尿道憩室或尿道狭窄.清洁间歇导尿是神经性膀胱的首要治疗方法,对于后尿道憩室可行尿道憩室切除术.     

脊髓发育不良患儿尿路功能的早期评价和处理

目的探讨早期评价和干预治疗对脊髓发育不良所致的神经原性膀胱患儿上尿路和膀胱功能的影响。方法回顾性分析1997-2003年收治的脊髓发育不良，尿流动力学显示存在膀胱高压和／或逼尿肌括约肌不协调的75例年龄在1岁以内神经原性膀胱患儿，其中30例从发现高危因素后即开始应用间歇导尿和抗胆碱能药物治疗的患儿作为研究组，随访数年，记录上尿路功能、膀胱功能及手术干预情况，与其余没有进行间歇导尿和抗胆碱能药物治疗的患儿（对照组）进行比较。结果平均随访时间6．6年（3．6～9．8年），研究组共30例患儿，在随访期间2例出现上尿路持续性扩张，2例膀胱输尿管反流，3例膀胱顺应性差，最终5例行膀胱扩大术；对照组除去7例失访，38例中18例上尿路扩张，15例膀胱输尿管反流，23例膀胱顺应性下降，26例行膀胱扩大术，上尿路损害和最终需行膀胱扩大术的病例研究组明显低于对照组。结论脊髓发育不良所致的神经原性膀胱，病理损害是逐渐加重的，如早期进行尿流动力学评价，针对高危因素早期预防性治疗对保护肾脏和膀胱功能，控制尿失禁，减少膀胱扩大术，被证实是有效的。     

经尿道瓣膜切开手术对后尿道瓣膜合并膀胱输尿管反流的影响

目的探讨经尿道瓣膜切开手术后后尿道瓣膜合并膀胱输尿管反流及肾积水的变化情况。方法回顾性分析首都医科大学北京儿童医院2010年1月至2016年1月收治的19例后尿道瓣膜合并膀胱输尿管反流患儿的临床资料。患儿年龄6～182个月,平均(27.4±7.2)个月;单侧反流12例,双侧反流7例;均行经尿道瓣膜切除术。分析患儿术前、术后6个月及术后1年肾盂前后径、输尿管宽度、肾实质厚度及膀胱输尿管反流程度的变化情况。结果 19例术后随访13～84个月,平均(38. 8±9. 8)个月;与术前相比,患儿术后1年肾盂前后径及输尿管宽度变小,肾实质厚度增加(P0.05);术后1年膀胱输尿管反流消退比例为68.4%(13/19),术后6个月轻度反流和重度反流改善率分别为40%和36. 3%,术后1年分别为53.3%和45.4%。对6例瓣膜切开术后仍有持续反流的患儿行尿动力学检查,其中4例表现为逼尿肌不稳定,3例表现为膀胱顺应性差。结论经尿道瓣膜切开手术可以改善后尿道瓣膜所致的膀胱输尿管反流及肾积水,对于后尿道瓣膜切开术后反流仍持续或加重的患儿建议行尿动力学检查,并随访膀胱功能。     

托特罗定在小儿神经原性膀胱的应用评价

目的 评价托特罗定治疗小儿神经原性膀胱的有效性和安全性.方法 随访126例2002年1月至2009年9月收治的神经原性膀胱患儿,男71例,女55例,年龄(6.2±3.1)岁,全部病例行清洁间歇导尿,81例同时服用托特罗定(0.1 mg·kg-1·d-1,2次/d),45例未服用托特罗定.就诊时和治疗3个月后分别行尿动力学和临床评价.结果 导尿+药物组中8例因副作用终止治疗,其中3例出现口干,2例头晕,3例便秘加重,73例坚持服用托特罗定.就诊时导尿组膀胱容量、膀胱顺应性、逼尿肌压分别为(119.3±19.6)ml、(4.0±1.1)ml/cmH2O、(56.7±10.4)cmH2O.3个月后膀胱容量、膀胱顺应性、逼尿肌压压分别为(122.0±20.1)ml、(4.1±1.1)ml/cmH2O、(55.8±10.9)cmH2O,无明显变化.11例(24.4%)逼尿肌过度活动减轻,13例(28.9%)漏尿分数下降.药物+导尿组就诊时膀胱容量、膀胱顺应性、逼尿肌压分别为(119.8±17.6)ml、(4.4±1.3)ml/cmH2O、(55.1±11.7)cmH2O,3个月后膀胱容量、膀胱顺应性、逼尿肌压分别为(149.6±23.1)ml、(7.5±2.3)ml/cmH2O、(38.4±11.6)cmH2O,膀胱容量、膀胱顺应性明显增加,膀胱内压降低.58例(79.5%)逼尿肌过度活动减轻,53例(73%)漏尿分数下降及家长表示满意.结论 托特罗定可抑制逼尿肌过度活动,降低膀胱内压,增加膀胱顺应性和膀胱容量,较少有副作用,有利于保护上尿路功能,并可减轻尿失禁的程度,对于反射亢进型小儿神经原性膀胱的治疗是安全、有效的.

Abstract：

Objective To evaluate the efficacy and safety of tolteroding to treat neurogenic bladder in children. Methods 126 patients (71 boys and 55 girls of 6. 2 ± 3. 1 years old) with hyperreflexia neurogenic bladder who were treated during January 2002 to September 2009 were followed up. All patients were performed clean intermittent catheterization. 81 patients took tolterodine(0. 1mg· kg-1 ·d-1 ,2 times/d) and 45 patients did not use tolterodine. Urodynamic and leakage score were evaluated before the treatment and 3 months later. Results 8 patients stopped tolterodine due to side effect,such as dry mouth in 3, dizziness in 2, sever constipation in 3. 73 patients took tolterodine all the time. Before treatment, the bladder volume, compliance and detrusor pressure in catheterization group were 119. 3 ± 19. 6 ml、4. 0 ± 1. 1ml/cmH2O 、56. 7 ± 10. 4 cmH2O, respectively. Three months after the treatment, bladder volume, compliance and detrusor pressure were 122. 0 ± 20. 1 ml、4. 1 ± 1. 1ml/cmH2O 、 55. 8 ± 10. 9 cmH2O, respectively. There was no significant difference. Detrusor overactivity in 11 patients(24. 4％)and leakage score in 13 patients (28. 9％)decreased. Bladder volume, compliance and detrusor pressure in catheterization + tolterodine group in the beginning were 119. 8 ± 17. 6ml、4. 4 ± 1.3ml/cmH2O 、 55. 1 ± 11.7 cmH2O, respectively. 3 months later, bladder volume, compliance and detrusor pressure were 149. 6 ± 23. 1 ml、7. 5 ± 2. 3ml/cmH2O 、38. 4 ± 11.6 cmH2O, respectively. Bladder volume and compliance increased and detrusor pressure decreased significantly. Detrusor overactivity in 58 patients(79. 5％)and leakage score in 53 patients(73％)decreased. The parents satisfied with this result. Conclusions Tolterodine could inhibit the detrusor overactivity, so it could decrease detrusor pressure and increase bladder volume and compliance and protect kidney. It was effective to the children with hyperreflexia nerurogenic bladder.     

清洁间歇导尿在小儿神经源性膀胱治疗中的价值

目的 评价清洁间歇导尿在小儿神经源性膀胱治疗巾的临床意义.方法 脊髓栓系综合征患儿64例.男49例,女15例,年龄3～13岁.均已行脊髓栓系松解手术.临床表现为尿失禁,611例合并大便失禁.52例合并足畸形.就诊时和就诊后1年分别行尿动力学和排泄件膀胱尿道造影以及超声检查,治疗期间36例坚持间歇导尿.28例未能坚持间歇导尿.结果 导尿组开始有9例合并Ⅲ°以下输尿管反流.4例为单纯肾积水.膀胱容量、顺应性、逼尿肌压分别为(176±34.5)ml、(3.5±0.6)ml/cmH2O、(54.6±13.2)cmH2O.1年后3例输尿管反流消失,2例肾积水减轻,膀胱容量、顺应性、逼尿肌压分别为(188±30.3)ml、(3.7±0.9)ml/cmH2O、(50.6±11.8)cmH2O,4例发生尿路感染(11.1%).未导尿组开始有7例合并Ⅲ°以下输尿管反流,5例为单纯肾积水,膀胱容量、顺应性、逼尿肌压分别为(168±37.2)ml,(3.2±0.7)ml/cmH2O,(59.6±15.6)cmH2O.1年后13例合并输尿管反流.9例合并肾积水.膀胱容量、顺应性、逼尿肌压分别为(142±23.6)ml,(1.6±0.7)ml/cmH2O,(72.4±9.3)cmH2O.3例发生尿路感染(10.7%).结论清洁间歇导尿可保护膀胱功能.避免或减轻上尿路功能的损害,并不增加尿路感染的发生率.对于神经源性膀胱治疗有重要的应用价值.     

神经源性膀胱伴输尿管反流的尿动力学研究

目的 探讨有输尿管反流的神经源性膀胱(NB)患儿有或没有逼尿肌过度活动(DO)时的尿动力学差异,为临床治疗此类患儿提供理论参考依据.方法 选取2013～2015年就诊并经影像尿动力学检查发现膀胱输尿管反流的NB患儿68例,男30例,女38例,年龄4～12岁,平均7.5岁.按照充盈期有DO,将其分为DO组(n=20)与无DO组(n=48).观察记录两组发生膀胱输尿管反流时的膀胱灌注量、逼尿肌压并计算发生反流时的膀胱顺应性;记录两组充盈结束时最大膀胱测压容量、最大逼尿肌压、并计算充盈期膀胱顺应性.结果 DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为(98.7±16.1)ml和(5.2±1.9) ml/cmH2O,无DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为(127.3±36.3)ml,(7.1±2.1)ml/cmH2O,差异均有统计学意义(P＜0.05);两组的逼尿肌压分别为(21.6±9.2)cmH2O、(19.2±7.4)cmH2O,差异没有统计学意义;DO组充盈结束时的膀胱容量与顺应性分别为(182.7±31.2)ml、(5.4±1.7) ml/cmH2O,与无DO组充盈结束时的膀胱容量(230.6±34.6)ml与顺应性(6.5±1.1)ml/cmH2O相比,差异有统计学意义;两组尿动力学检查结束时逼尿肌压分别为(33.8±7.8)cmH2O、(36.4±8.1)cmH2O,差异没有统计学意义.结论 膀胱容量小,膀胱顺应性差是有输尿管反流的NB患儿伴发DO时的尿动力学特征.     

Management of vesicoureteral reflux secondary to neurogenic bladder

The authors encountered 108 cases of vesicoureteral reflex (VUR) in 231 cases of neurogenic bladder complicating spina bifida. Bladder compliance and percent volume (% vol.) were measured pre- and postoperatively and the patients were divided into four groups retrospectively according to the treatment. Ninety-five percent of low-grade VUR (grades I and II) disappeared spontaneously with conservative therapy or after augmentation cystoplasty without antireflux surgery; 92% of high-grade VUR (grade III or more) required ureteral reimplantation with or without bladder augmentation. Reflux did not recur in any case of ureteral reimplantation with bladder augmentation, however, it did recur in 20.4% of the cases of simple ureteral reimplantation without bladder augmentation. Percent volume and bladder compliance in cases of recurrence following simple ureteral reimplantation were significantly lower than in the successful cases. This study suggests that low-grade VUR can resolve spontaneously with conservative therapy or with a suitable maneuver to improve bladder compliance. High-grade reflux in cases of preserved bladder volume (% vol.>75%) and compliance (>7 ml/cmH₂O) can be treated successfully with simple ureteral reimplantation, however, in cases of low volume (% vol.<60%) and low compliance (<4 ml/cmH₂O), reimplantation with bladder augmentation is recommended. Accepted: 6 January 1998     

Ureterocystoplasty (bladder augmentation) with a solitary kidney

Children who develop end-stage renal disease (ESRD) as a result of obstructive uropathies require evaluation and treatment of associated bladder dysfunction to ensure a good outcome following renal transplantation. Bladder dynamics can often be optimized medically, although surgical intervention is occasionally necessary. For those patients who require bladder augmentation, the use of a dilated native ureter (ureterocystoplasty) is preferred to the more commonly used intestine or stomach (enterocystoplasty), which carry a higher risk of complications. Unfortunately, most patients do not have a suitable anatomy for ureterocystoplasty and, by necessity, intestine or stomach has to be utilized. Herein, we describe the successful application of ureterocystoplasty in the presence of ESRD and a solitary kidney prior to renal transplantation. We believe that owing to the many advantages of native urothelium, every effort should be made to use ureter and avoid the use of intestine.     

Comparison of traditional enterocystoplasty and seromuscular colocystoplasty lined with urothelium

ObjectiveTo evaluate long-term outcomes between various methods of augmentation cystoplasty.MethodsA retrospective analysis was performed of patients undergoing seromuscular colocystoplasty lined with urothelium (SCLU, n = 26), and their outcomes compared to a similar population of patients in the same institution who had received traditional forms of bladder augmentation (colocystoplasty and ileocystoplasty, n = 32). Measurements included efficacy of the procedure in increasing bladder capacity and achieving urinary continence, and the need of subsequent surgery for complications.ResultsThere was no statistically significant difference in achieved bladder capacity, subjective urinary continence and the rates of subsequent surgery for stones, vesicoureteral reflux, augment failure, bladder neck continence and catheterizable channel. None of the patients in the SCLU group had spontaneous perforation or small bowel obstruction.ConclusionPatients with SCLU are at decreased risk for bowel obstruction and spontaneous perforation, but are not devoid of other long-term complications including bladder stones, vesicoureteral reflux and augment failure. Most of the risks and benefits of augmentation cystoplasty performed using ileum, colon, or SCLU appear similar.     

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.