CYSTECTASY AND REHABILITATION TRAINING FOR TREATMENT OF NEUROGENIC BLADD ER DY SFUNCTION WITH HYPERREFLEXIA_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LILuping ,  FANYingzhong , LIHao , ZHANGQian , GOULi

Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P. R. China;

Corresponding?author：

FANYingzhong, Email: fanyingzhong2@163.com

Keywords：

Neurogenic bladder; Hyperreflexia; Cystectasy; Rehabilitation training

DOI：

10.7507/1002-1892.20160046

Video：

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Objective To investigate the effectiveness of ileal mucosal seromuscular patch for bladder expansion combined with rehabilitation training for treating neurogenic bladder dysfunction (NBD) with hyperreflexia. Methods A retrospective study was performed on the clinical data of 61 patients with NBD and hyperreflexia who were treated and followed up between July 2008 and June 2013. There were 36 males and 25 females, aged 6-23 years (mean, 10 years). The reasons included meningomyelocele operation (43 patients), surgery for lipoma in lumbar vertebra (4 patients), operation of thoracolubar teratoma (2 patients), and lumbosacral spina bifida (12 patients). The results of urodynamics indicated that bladder volume decreased obviously and the residual urine increased. The voiding cystourethrography (VCUG) showed the vesicoureteral reflux (VUR), including 6 cases (10 sides) of grade V, 7 cases (12 sides) of grade IV, and 6 cases (8 sides) of grade III. The color doppler ultrosound showed mild hydronephrosis in 23 cases (41 sides), moderate hydronephrosis in 25 cases (42 sides), and severe hydronephrosis in 13 cases (22 sides). The blood biochemical examination suggested chronic renal failure (CRF) in 13 cases. The treatment included augmentation for bladder and rehabilitation training after operation. Results The operation time was (157±26) minutes; the intraoperative blood loss was (43±15) mL, and no patient was given blood transfusion. The patients were followed up 1.5-6.0 years (mean, 4.5 years). Vesical fistula occurred in 4 cases, urinary infection in 5 cases, dysuresia in 2 cases, and cystolith in 1 case after operation. At 1 year after operation, the International Consultation on Incontinence Questionnaire-Urinary Incontience Short Form (CIQ-SF) score was significantly better than preoperative score (H=89.813, P=0.000). The urodynamic data showed that the difference value between observed and theoretical bladder volumes, bladder compliance, residual urine volume, maximum flow rate, and maximum storage detrusor pressure were significantly better than preoperative ones (P<0.05). And the color doppler ultrasound showed mild hydronephrosis in 34 cases (56 sides), moderate hydronephrosis in 18 cases (33 sides), and severe hydronephrosis in 9 cases (16 sides). VCUG showed that bladder volume obviously increased, no contracture was observed; and VUR was improved. And renal function was improved in 13 patients with CRF. Conclusion Ileal mucosal seromuscular patch for bladder expansion combined with postoperative rehabilitation training has good effectiveness in treating NBD with hyperreflexia.

Citation： LILuping, FANYingzhong, LIHao, ZHANGQian, GOULi. CYSTECTASY AND REHABILITATION TRAINING FOR TREATMENT OF NEUROGENIC BLADD ER DY SFUNCTION WITH HYPERREFLEXIA. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(2): 224-228. doi: 10.7507/1002-1892.20160046 Copy

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13.	羅德毅, 楊童欣, 林逸飛, 等. 單純腸道膀胱擴大術治療神經源性膀胱合并輸尿管反流的初步結果. 中華泌尿外科雜志, 2015, 36(2):104-107.
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15.	陳雨歷, 李金良, 談玲玲, 等. 腸管漿肌層補片膀胱擴大術治療反射亢進型神經性膀胱(附21例報告). 中華泌尿外科雜志, 1995, 16(4):213-215.
16.	Salle JL, Fraga JC, Lucib A, et al. Seromuscular enterocystplasty in dogs. J Urol, 1990, 144(2 Pt 2):454-456.
17.	Abdul-Rahman A, Attar KH, Hamid R, et al. Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladders. BJU Int, 2010, 106(6):827-830.
18.	王家祥, 張大, 范應中. 回腸漿肌層補片膀胱擴大術治療反射亢進型神經原性膀胱療效隨訪. 中華醫學雜志, 2005, 85(15):1060-1061.
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1. ?黃澄如. 實用小兒泌尿外科學. 北京:人民衛生出版社, 2006:481-482.
2. 張金哲, 潘少川, 黃澄如. 實用小兒外科學. 杭州:浙江科學技術出版社, 2003:1054-1068.
3. Goetz LL, Klausner AP. Strategies for prevention of urinary tract infections in neurogenic bladder dysfunction. Phys Med Rehabil Clin N Am, 2014, 25(3):605-618.
4. Schwartz J, Iselin C. Management of neurogenic bladder. Rev Med Suisse, 2009, 5(228):2453-2456.
5. 鄒典定. 現代兒科診療學. 北京:人民衛生出版社, 2002:944.
6. Danforth TL, Giusberg DA. Neurogenic lower urinary tract dysfunction:how, when, and with which patients do we use urodynamics? Urol Clin North Am, 2014, 41(3):445-452.
7. 張萬生, 于航, 郭彬彬, 等. 尿流動力學的臨床應用評價. 中國衛生管理標準, 2015, 6(28):82-83.
8. Polackwich AS, Skoog SJ, Austin JC. Long-term followup after endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid copolymer in patients with neurogenic bladder. J Urol, 2012, 188(4Suppl):1511-1515.
9. Korzeniecka Kozerska A, Zauada BO, Skutaik JM, et al. The assessment of thiol status in children with neurogenic bladder caused by meningomyelocele. Urol J, 2014, 11(2):1400-1405.
10. Baek M, Kang JY, Joeng J, et al. Treatment outcomes according to neuropathic bladder sphincter dysfunction type after treatment of oxybutynin chloride in children with myelodysplasia. Int Urol Nephrol, 2013, 45(3):703-709.
11. Horst M, Weber DM, Bodmer C, et al. Repeated Botulinum-A toxin injection in the treatment of neuropathic bladder dysfunction and poor bladder compliance in children with myelomeningocele. Neurourol Urodyn, 2011, 30(8):1546-1549.
12. Cain MP, Rink RC. Augmentation for neuropathic bladder dysfunction-a thing of the past? J Urol, 2010, 183(6):2124-2125.
13. 羅德毅, 楊童欣, 林逸飛, 等. 單純腸道膀胱擴大術治療神經源性膀胱合并輸尿管反流的初步結果. 中華泌尿外科雜志, 2015, 36(2):104-107.
14. Buson H, Manivel JC, Dayan? M, et al. Seromuscular colocystoplasty lined with urothelium:experimental study. Urology, 1994, 44(5):743-748.
15. 陳雨歷, 李金良, 談玲玲, 等. 腸管漿肌層補片膀胱擴大術治療反射亢進型神經性膀胱(附21例報告). 中華泌尿外科雜志, 1995, 16(4):213-215.
16. Salle JL, Fraga JC, Lucib A, et al. Seromuscular enterocystplasty in dogs. J Urol, 1990, 144(2 Pt 2):454-456.
17. Abdul-Rahman A, Attar KH, Hamid R, et al. Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladders. BJU Int, 2010, 106(6):827-830.
18. 王家祥, 張大, 范應中. 回腸漿肌層補片膀胱擴大術治療反射亢進型神經原性膀胱療效隨訪. 中華醫學雜志, 2005, 85(15):1060-1061.
19. 張帆, 廖利民, 陳國慶. 組織工程補片膀胱擴大術治療神經源性膀胱的療效分析. 中華泌尿外科雜志, 2015, 36(1):29-34.

Chinese Journal of Reparative and Reconstructive Surgery

CYSTECTASY AND REHABILITATION TRAINING FOR TREATMENT OF NEUROGENIC BLADD ER DY SFUNCTION WITH HYPERREFLEXIA

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