[CYSTECTASY AND REHABILITATION TRAINING FOR TREATMENT OF NEUROGENIC BLADDER DYSFUNCTION WITH HYPERREFLEXIA].

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 B3ifida (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 (IQ-F) score was significantly better than peoperative score (H=9.813, P=0.000). The aurdynmic 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

Heal mucosal seromuscular patch for bladder expansion combined with postoperative rehabilitation training has good effectiveness in treating NBD with hyperreflexia.