AmpliaÃÃo vesical nÃo secretÃria: estudo prospectivo de 15 anos

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Introduction and Objective: Children and young adults submitted to augmentation procedures with total intestinal flaps are at higher risk of developing complications on the long term follow up. The aim of the present study is to show the long-term results of demucosalized bladder augmentation. Patients and methods: One hundred and eighty three patients -92 males and 91 females- were submitted to a bladder augmentation utilizing de-epithelialized intestinal segments. Here are included 10 patients that were readmitted to the study due to failure of the initial augmentation. The age ranged from 3 months to 53 years old with a mean of 13.51 (median 11.0). One hundred and twenty-one (66.1%) patients were diagnosed as neurogenic bladder, 50 (27.3%) had bladder exstrophy, 04 (2.2%) had sequelae of posterior urethral valves, 7 (3.8%) had been treated for urinary tuberculosis and 01(0.5%) had female hypospadias. A balloon, where the de-epithelialized segment of bowel was applied over, was used in all patients. In the first 24 patients this balloon was made of a diverticulum created by the bladder mucosa. The remaining patients had a fine silicone balloon instead of the mucosal diverticulum. One hundred fifty-one patients were augmented utilizing a segment of de-epithelialized colon. In 32 patients a segment of ileum was used instead. All patients underwent a complete urologic workup, which included urinalysis, ultrasonography, cystography and urodynamics. All tests were repeated every 3 months during the first year and repeated annually. The clinical status concerning improvement in the condition of the reservoir, improvement of upper tract dilatation as well as data from bladder capacity and compliance were used to evaluate the results. Results: The mean follow-up for the whole group of patients was 75.6 months (02-189). Twenty three (12.6%) cases were considered as failures due to loss of compliance and/or deterioration of the upper tract. The mean bladder capacity for the whole group was 294.96ml. When compared to the mean value of 94.90mL in the preoperative period represents an increase of 308.70%. Seven patients in the exstrophy group presented bladder stones. Spontaneous bladder perforation was found in 2 cases. The mean preoperative compliance was 1.9ml/cm/H2O. When compared to the mean value of 13.6mL/cm/H2O, represents an increase superior to 7-fold. Conclusions: A significant increase in bladder capacity and compliance was achieved and maintained in the long run. Improvement of upper tract dilatation was observed in all cases considered as success. The number of complications was lower when compared to traditional methods of augmentation

ASSUNTO(S)

incontinÃncia urinÃria enterocystoplasty urinary incontinence bexiga neurogÃnica cirurgia enterocistoplastia neurogenic bladder

ACESSO AO ARTIGO

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