背景:自1997年成立以来,完全泌尿生殖系统动员(TUM)一直是泄殖腔畸形(CM)泌尿生殖系统的标准手术方法。CM中的部分泌尿生殖器动员(PUM)仍然是一个未充分利用或报告不足的选择。TUM和PUM之间的主要解剖学差异是阴尿道韧带的分裂。
目的:我们在部分CM患者中探索了PUM的可行性,并报告了早期结局。
方法:我们回顾性回顾了2012年至2020年在我们中心进行初次重建的所有CM患者的前瞻性收集数据。我们在审查中纳入了接受PUM的患者。Mullerian异常,脊髓受累,公共信道长度(CC),尿道长度(UL),外科重建,结果包括尿失禁,复发性UTI,超声和术前DMSA/MAG3,膀胱阴道镜后重建,并注意到无效后的残留物。
结果:53例患者进行了初次重建,其中,11个有一个小于3厘米的公共通道。在十一人中,只有一个人接受了TUM。在PUM组中,其中两人进行了丝线分离(20%)。5例患者(50%)发现穆勒重复。中值CC长度=1.6cm(范围=1.5cm-2.7cm),和中值UL=1.5cm(范围=1.5cm-2.5cm)。随访9~134个月(中位数=63个月)。在检查和膀胱阴道镜检查中,重建后都有单独的尿道和阴道开口。节制结果总结在图1中。
结论:尽管TUM是CM中泌尿生殖系统最常见的解决方案,一个子集将适合PUM,并且此选项在文献中使用不足或报道不足。我们假设许多拥有TUM的人可能只需要一个PUM,因此可以从膀胱功能方面报告更好的结果。区分两者很重要,结果应该适当分类。我们的默认方法是所有CM中的PUM,公共信道小于3厘米。只有泌尿生殖道复合体的外侧和后部被动员,如果尿道没有达到令人满意的水平,以便进行间歇性导尿,然后我们进行TUM,将阴尿道韧带分开。PUM避免了与TUM中尿道韧带分裂相关的潜在并发症。它还可以避免在接受TUM的患者中遇到的CIC的需要。
结论:PUM是泄殖腔畸形的可行替代方法,在具有3厘米以下共同通道的患者中效果良好。当然,这需要适当的患者选择和干预措施的准确分类,以了解真正的结果。
Total Urogenital Mobilization (TUM) has been the standard surgical approach for the urogenital complex in Cloacal Malformations (CM) since its inception in 1997. Partial Urogenital Mobilization (PUM) in CM remains an under-utilized or under-reported option. The main anatomical difference between TUM and PUM is the division of the pubo-urethral ligaments.
We explored the feasibility of PUM in a select subset of our patients with CM and report early outcomes.
We retrospectively reviewed prospectively collected data of all our CM patients who had primary reconstruction at our centre from 2012 to 2020. We included in our review the patients who underwent PUM. Mullerian abnormalities, spinal cord involvement, common channel length (CC), urethral length (UL), surgical reconstruction, and outcomes including urinary continence, recurrent UTI, ultrasound and preoperative DMSA/MAG3, cystovaginoscopy post-reconstruction, and post-void residuals were noted.
Fifty-three patients had primary reconstruction, and of these, eleven had a common channel less than 3 cm. Of the eleven, only one underwent TUM. In the PUM group, two underwent filum untethering (20%). Mullerian duplication was noted in 5 patients (50%). The median CC length = 1.6 cm (range = 1.5cm-2.7 cm), and median UL = 1.5 cm (range = 1.5cm-2.5 cm). Follow-up ranged from 9 to 134months (median = 63months). Post-reconstruction all had a separate urethral and vaginal opening on examination and cysto-vaginoscopy. The continence outcomes are summarized in Fig.1.
Although TUM is the most common solution for the urogenital complex in CM, a subset would be suitable for PUM, and this option is under-utilized or under-reported in literature. We presume that many who had TUM probably only needed a PUM, and therefore could report better outcomes from a bladder function aspect. It is important to differentiate the two, and outcomes should be appropriately categorized. Our default approach is a PUM in all CM with less than 3 cm common channel. Only the lateral and posterior aspects of the urogenital complex are mobilized and if the urethra did not reach a satisfactory level for easy intermittent catheterization, then we proceed to a TUM dividing the pubo-urethral ligaments. PUM avoids the potential complications related to dividing the pubo-urethral ligament in TUM. It may also avoid the need for CIC which is encountered in patients who undergo TUM.
PUM is a viable alternative in cloacal malformations with good outcomes in those with a common channel under 3 cm. This of course requires appropriate patient selection and accurate categorization of interventions to understand the true outcomes.