PDF(Pubmed)
Abstract：
UNASSIGNED: Lower urinary tract dysfunction (LUTD) in cerebral palsy (CP) and other neuromuscular diseases can present with chronic retention that leads to hydronephrosis, recurrent urinary tract infections (UTI), and stone formation. Whenever the conservative treatment of LUTD fails for any reason, it is considered to be complicated LUTD, in which a surgical approach is warranted. Cutaneous vesicostomy (CV) is a simple, well-tolerated, and potentially reversible procedure that protects the upper tracts. We describe our experience using CV for this complex population.
UNASSIGNED: Children with CP and other neuromuscular diseases admitted to pediatric long-term care units for palliative care between 2015 and 2019 were included in the study. They present multi-system involvement, polypharmacy, and Gross Motor Function Classification System levels of 4 or 5. We retrospectively studied this population\'s indications and results of CV.
UNASSIGNED: Of the 52 admitted patients, 18 presented LUTD with UTI (n:18; 100%), stones (n:5; 28%), progressive hydroureteronephrosis (n:3; 17%), or stones (n:2; 11%). Conservative initial management (catheterizations, prophylaxis antibiotics) was effective in half the cases. The remaining nine were defined as complicated LUTD and underwent CV. After a mean follow-up of 11.3 months, the follow-up showed improved hydronephrosis in all nine (100%) patients. Recurrent UTIs were no longer seen in eight of nine patients, although three patients required bladder irrigations; bladder stones did not recur after CV; the kidney stones needed further intervention. Revision of the CV was required in two (11%) cases at 12 and 24 months postoperatively due to stoma stenosis.
UNASSIGNED: CV is a relatively simple and effective procedure representing a pragmatic solution for managing complicated LUTD in complex long-term institutionalized pediatric palliative care patients with neuropathic bladders.
UNASSIGNED: Children with CP and other neuromuscular diseases admitted to pediatric long-term care units for palliative care between 2015 and 2019 were included in the study. They present multi-system involvement, polypharmacy, and Gross Motor Function Classification System levels of 4 or 5. We retrospectively studied this population\'s indications and results of CV.
UNASSIGNED: Of the 52 admitted patients, 18 presented LUTD with UTI (n:18; 100%), stones (n:5; 28%), progressive hydroureteronephrosis (n:3; 17%), or stones (n:2; 11%). Conservative initial management (catheterizations, prophylaxis antibiotics) was effective in half the cases. The remaining nine were defined as complicated LUTD and underwent CV. After a mean follow-up of 11.3 months, the follow-up showed improved hydronephrosis in all nine (100%) patients. Recurrent UTIs were no longer seen in eight of nine patients, although three patients required bladder irrigations; bladder stones did not recur after CV; the kidney stones needed further intervention. Revision of the CV was required in two (11%) cases at 12 and 24 months postoperatively due to stoma stenosis.
UNASSIGNED: CV is a relatively simple and effective procedure representing a pragmatic solution for managing complicated LUTD in complex long-term institutionalized pediatric palliative care patients with neuropathic bladders.
摘要：
■脑瘫（CP）和其他神经肌肉疾病的下尿路功能障碍（LUTD）可表现为导致肾积水的慢性滞留，复发性尿路感染（UTI），和石头形成。每当LUTD的保守治疗因任何原因失败时，它被认为是复杂的LUTD，其中手术方法是必要的。皮肤膀胱造口术（CV）是一个简单的，耐受性良好,以及保护上消化道的潜在可逆程序。我们描述了我们对这个复杂人群使用CV的经验。
■在2015年至2019年期间被送往儿科长期护理单位接受姑息治疗的CP和其他神经肌肉疾病儿童被纳入研究。他们表现出多系统的参与，多药，和粗大运动功能分类系统的4或5级。我们回顾性研究了该人群的适应证和CV结果。
■在52名入院患者中，18呈现了带有UTI的LUTD（n：18；100％），石头（n：5；28%），进行性输尿管肾积水（n：3；17％），或石头（n：2；11％）。保守的初始管理（导管插入，预防性抗生素）在一半的病例中有效。其余9例被定义为复杂的LUTD并接受了CV。平均随访11.3个月后，随访结果显示,所有9例(100%)患者的肾积水得到改善.9名患者中有8名不再出现复发性尿路感染，尽管3例患者需要膀胱冲洗;CV后膀胱结石未复发;肾结石需要进一步干预.由于造口狭窄，2例（11％）在术后12个月和24个月需要修改CV。
■CV是一种相对简单而有效的程序，代表了在复杂的长期住院儿科姑息治疗患有神经性膀胱的患者中管理复杂LUTD的实用解决方案。
■在2015年至2019年期间被送往儿科长期护理单位接受姑息治疗的CP和其他神经肌肉疾病儿童被纳入研究。他们表现出多系统的参与，多药，和粗大运动功能分类系统的4或5级。我们回顾性研究了该人群的适应证和CV结果。
■在52名入院患者中，18呈现了带有UTI的LUTD（n：18；100％），石头（n：5；28%），进行性输尿管肾积水（n：3；17％），或石头（n：2；11％）。保守的初始管理（导管插入，预防性抗生素）在一半的病例中有效。其余9例被定义为复杂的LUTD并接受了CV。平均随访11.3个月后，随访结果显示,所有9例(100%)患者的肾积水得到改善.9名患者中有8名不再出现复发性尿路感染，尽管3例患者需要膀胱冲洗;CV后膀胱结石未复发;肾结石需要进一步干预.由于造口狭窄，2例（11％）在术后12个月和24个月需要修改CV。
■CV是一种相对简单而有效的程序，代表了在复杂的长期住院儿科姑息治疗患有神经性膀胱的患者中管理复杂LUTD的实用解决方案。
