Власний досвід реконструктивно-пластичних операцій на сечовому міхурі в дітей

Abstract

In our country, complex surgical reconstruction of the distal urinary tract in severe bladder dysfunction in children is performed infrequently, given the number of children who need these operations. These operations were carried out in our country by specialists invited from abroad. Therefore, we want to share our first experience of performing a complex surgical reconstruction of the distal urinary tract in children. Purpose – to іmprove the quality of life of children with severe bladder dysfunction. Materials and methods. The results of reconstructive and plastic operations on the bladder in 7 children with severe bladder dysfunction were analyzed. Four patients had a neurogenic bladder 3 of them had a spinal bladder), and two patients had a microcyst after surgical correction of bladder exstrophy and total epispadias. Augmentation ileocystoplasty was performed in 3 children, two of them also underwent appendicocystostomy, 3 patients underwent only appendicocystostomy. An assessment of the urinary tract condition, the degree of urinary retention, postoperative complications and quality of life of operated children. Results. All operated children recovered. The bladders in three patients after augmentation have sufficient volume and fully provide reservoir function. We did not observe metabolic acidosis or other serious metabolic disorders described by other authors in the children we operated on. Urolithiasis was also not observed after surgery. In 5 patients who underwent appendicocystostomy, the latter is well catheterized, has a good cosmetic effect. In 4 out of 5 patients there is no leakage of urine through the stoma. All operated children were recovered for vesicoureteral reflux and chronic pyelonephritis. According to the results of the survey, the improvement of most parameters of quality of life of operated patients (cessation of urinary tract infection, complete urinary retention with more infrequent and controlled urination, the ability to visit children’s groups and social adaptation of these children in society). Conclusions. Based on the first own experience of augmentation ileocystoplasty and appendicocystostomy according to Mitrofanoff, the good efficiency of these reconstructive-plastic operations is noted. In all operated patients the quality of life significantly improved – controlled urination was achieved, the progression of kidney damage was stopped. All postoperative complications are successfully corrected. Of great importance for achieving a good effect of treatment is the correct choice of the the urinary tract surgical reconstruction type in each case. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: augmentation ileocystoplasty, appendicocystostomy, children.