METHODS OF SURGICAL RECONSTRUCTION IN THE SEVERE CASES
OF DETRUSION DISTURBANCES IN CHILDREN
I.B. Osipov, V.V. Levanovich, A.I.
Osipov
St. Petersburg State Paediatric Medical Academy, St. Petersburg,
Russia
Reconstruction of reservoir and evacuator functions of the
bladder is a difficult task in children who suffer extrophy and neurogenic
dysfunction of the bladder.
The study aimed to work out surgical approaches to paediatric
patients with severe forms of bladder dysfunctions resulted from myelodysplasia
or extrophy after reconstructive surgical interventions in the cases when
either conservative treatment or the attempts to re-innervate pelvic organs
seem to be of no help.
The study covered 138
children with bladder extrophy who underwent reconstructive surgery and 183
children with neurogenic bladder dysfunction resulted from myelodysplasia
as a complication of inborn malformations or spinal trauma. In 44 children,
no adequate reservoir bladder capacity was accomplished despite its normal
sphincter function. To further increase its capacity, 39 children were
undergone augmenting procedure with the segment of ileum or sigma. In 178
cases with large residual urine volume, prolonged or periodic urethral
catheterisation was performed; in 7 cases encountering certain technical
problems and/or patient’s incompliance, appendicocystocutaneostomia for
self-catheterisation was performed. Complete lack of sphincter activity in
14 children was an indication for urethral closure in combination with
Mitrofanoff surgery. Patients who underwent above surgical approaches did
not suffer from urine incontinence for quite a long time; they did not have
obstructive symptoms. Pyelonephritis, if occurred in them, had a benign
course.
Differentiated approach
to the children with bladder dysfunction may help to improve health-related
quality of life in these patients.