背景:在出生时患有膀胱外翻-外翻综合征(BEEC)的儿童中,实现尿失禁是一个关键目标。不幸的是,尽管有时进行了广泛的手术治疗,但这一目标只能适度实现.因此,反复住院和手术可能会对生活质量产生负面影响。因此,我们认为,在BEEC患者失禁治疗的早期阶段,应探索保守治疗方案。作为其中的一部分,为BEEC重建手术后持续性尿失禁的患者提供了基于的强化尿路治疗方案.
目的:本研究的目的是评估强化尿路治疗对BEEC患儿术后尿失禁的益处。
方法:进行了一项回顾性图表研究,包括所有因BEEC重建手术后持续性尿失禁而纳入强化尿路治疗计划的儿童。尿路疗法包括基于认知行为疗法的为期十天的住院培训计划,有经验的泌尿外科医师的密集随访。主要结果测量是失禁,表示为治疗后实现完全失禁(良好结果;100%干燥)或每周湿天数减少50-99%(改善结果)的儿童百分比。
结果:分析了33例平均年龄为10.6岁的患者的数据。在61%的病例(20/33)中,据报道尿路治疗后尿失禁的改善或良好结果。患有经典膀胱外翻的儿童更常获得良好或改善的结果(13/16;81%),与外裂患儿相比(6/16;38%)。唯一患有泄殖腔外翻的患者完成了治疗,结果有所改善。从患有持续性尿失禁的患者组中,75%(12/16)报告说,在随访结束时,投诉在社会上是可以接受的。
结论:通过遵循我们的强化尿路治疗计划,大多数患者实现了完全失禁或改善了失禁。此外,我们的研究结果表明,住院培训计划对持续性尿失禁患者的接受度有积极影响。泌尿科治疗师提供个性化的护理和明确的指导,我们认为成功治疗的基本要素。考虑到重复手术可能会阻碍进展,并且不能保证节制,我们建议优先考虑保守治疗方案.
结论:我们的结果表明,37%(12/33)的BEEC患者因重建手术后持续性尿失禁而参加了我们的强化尿路治疗计划,尿路治疗后达到完全尿失禁,63%(21/33)仍有一定程度的尿失禁。75%的患者没有达到完全的尿失禁,将剩余的失禁描述为社会可接受的。这些发现强烈支持咨询BEEC患者在选择进一步手术之前考虑保守治疗。
BACKGROUND: Achieving urinary continence is a key goal in children born with the bladder exstrophy-epispadias complex (BEEC). Unfortunately, this goal is only moderately achieved despite sometimes extensive surgical treatment. Undergoing repeated hospitalization and operations may consequently have a negative impact on quality of life. We therefore believe that other, conservative treatment options should be explored in an earlier stage of incontinence treatment in BEEC patients. As part of this, an intensive urotherapy program based on was offered to patients with persistent incontinence after reconstructive surgery for BEEC.
OBJECTIVE: The aim of this study is to evaluate the benefits of intensive urotherapy on incontinence after reconstructive surgery in children with BEEC.
METHODS: A retrospective chart study was performed including all children who were enrolled in an intensive urotherapy program because of persistent incontinence after reconstructive surgery for BEEC. Urotherapy consisted of a ten-day inpatient training program based on cognitive behavioral therapy, with intensive follow-up by experienced urotherapists. Main outcome measurement was continence, expressed as the percentage of children that achieved complete continence (good result; 100% dry) or 50-99% decrease of wet days a week (improved result) after treatment.
RESULTS: Data of 33 patients with a mean age of 10.6 years were analyzed. In 61% of cases (20/33) an improved or good result was reported on incontinence after urotherapy. Children with classic bladder exstrophy more often achieved a good or improved result (13/16; 81%), compared to children with epispadias (6/16; 38%). The only patient with a cloacal exstrophy completed treatment with an improved result. From the group of patients with persistent incontinence, 75% (12/16) reported that the complaints were socially acceptable at the end of follow-up.
CONCLUSIONS: By following our intensive urotherapy program the majority of patients achieved complete continence or improved incontinence. In addition, our results show that the inpatient training program has a positive impact on acceptance in cases of persistent incontinence. The urotherapists offer individualized care and clear guidance, which we deem essential elements of successful treatment. Considering that repeated surgery may impede progress and offers no guarantee of continence, we recommend giving preference to conservative treatment options.
CONCLUSIONS: Our results show that 37% (12/33) of patients with BEEC who were enrolled in our intensive urotherapy program because of persistent incontinence after reconstructive surgery, achieved complete continence after urotherapy and 63% (21/33) still experienced some degree of incontinence. 75% of patients who did not achieve complete continence, described the remaining incontinence as socially acceptable. These findings strongly support counselling patients with BEEC to consider conservative treatment before opting for further surgery.