双侧输尿管膀胱颈重建

Bladder Neck Reconstruction with Bilateral Ureteral Reimplantation by Dr P P Singh

                               
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Just about the most challenging areas inside pediatric urology will be treating children using either anatomic or maybe neurogenic incontinence. The bladder neck is really a critically important construction in preventing lack of the urine through the bladder. Although anatomists will not agree on the precise arrangement of muscle fibers with the bladder neck, the particular consensus is that, during storage, the particular bladder neck have to remain closed. Besides maintaining closure through bladder filling, the bladder neck has to be stress competent. Most of these sphincteric properties have to become quiet through voiding, reverse their particular roles, and form a new compliant tube through which urine can move.

Urinary incontinence as a result of bladder neck incompetence is really a serious medical, social, and psychologic trouble for children, mothers and fathers, and caregivers. Reasons behind bladder neck incompetence inside children include neurogenic bladder (myelodysplasia, sacral agenesis, or maybe other congenital or maybe acquired lesions impacting the spinal cord), the particular exstrophy-epispadias complex, urogenital sinus abnormalities in gals, bilateral single ureteral ectopia, and trauma. The most frequent problem is the particular neurogenic bladder seen in children with myelodysplasia. Myelodysplasia occurs in approximately 3: 6 for every 10, 000 reside births. Most pediatric centers take care of hundreds of young children with myelodysplasia, and 70% of the children have the incompetent bladder throat. 14 One on the single most essential contributions to urology was the pioneering operate of Lapides11 which popularized clean spotty catheterization. This allowed the structure of bladder throat reconstruction procedures, which bring about complete urinary preservation. The use associated with clean intermittent catheterization, either with the urethra or a new Mitrofanoff16 stoma, enables these children for you to catheterize themselves and remain dry involving catheterizations. Dryness is just not synonymous with continence. The latter term signifies that the bladder throat is functional, finished during filling, and open during voiding.

When contemplating a child for bladder neck reconstruction, surgical goals have to first be set up. The goal in a child with exstrophy will be voluntary voiding using good control (continence), whereas the goal in a child with neurogenic bladder is normally dryness without voiding. Factors that advise the bladder neck reconstruction must be performed for continence consist of normal bladder innervation, usual detrusor muscle perform, a prior history of normal voiding, and correctable bladder throat anatomy. If these factors usually are not present, it becomes difficult to own goal of continence with any type of bladder neck reconstructive treatment. Factors that suggest that the bladder neck reconstruction must be performed for dryness consist of faulty innervation, the abnormal or nonfunctioning detrusor muscles, numerous prior was unable bladder neck reconstructive procedures for continence, plus the prior initiation of your intermittent catheterization system.

Most children wanting bladder neck reconstruction have neurogenic incontinence and need a procedure to build dryness. Therefore, procedures designed to restore bladder throat anatomy and physiology are seldom indicated. For instance , the Leadbetter, 12 the particular Tanagho, 24 among others. 5 and 23 The great majority of children require operations that creates a oneway valve-type mechanism9 and 20 or develop compression. 10 and 13 Most of these procedures create impediment, which causes usual and abnormal bladders to become hyperactive and noncompliant. For that reason, there are a small number of children who have to have bladder neck reconstruction for dryness which will not need a new simultaneous bladder enhancement. The bladder enhancement using bowel creates the latest set of potential problems that really must be addressed prior for you to choosing any approach. For example, the child with renal deficiency would do poorly having an augmentation procedure making use of large bowel.