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Strategies in urological reconstruction in myelomeningocele.

机译:脊髓膜腔膨出中泌尿科重建策略。

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PURPOSE OF REVIEW This paper reviews recent advances in the strategies for urinary tract reconstruction in children with spina bifida. The aims of reconstruction are the preservation of renal function and achievement of urinary continence. Considerable controversy exists on the subjects of bladder augmentation, procedures to increase outlet resistance, and continent stomas. The authors put the most recently published information in perspective in the light of their own personal experience.RECENT FINDINGS Thirty-seven papers covering the above-mentioned subjects published in the past 5 years (25 of them published since 2000) have been selected. Seven relevant older references are included. There is persistent interest in developing methods to enlarge the urinary bladder that avoid bringing the urine in contact with the intestinal mucosa. The artificial urinary sphincter and fascial slings are the most frequently reported methods to increase outlet resistance. The Mitrofanoff principle continues to be regarded as an effective method to construct a continent catheterizable channel, either with the appendix or reconfigured intestinal segments. The achievement of fecal continence has to be pursued in parallel with urinary continence. Incontinent diversions continue to be best for a small group of patients. The role of continent urinary diversion requires reassessment.SUMMARY Progress in this area continues to be made. Periodic, critical and objective reviews on the subject should help the practitioner to arrive at sound decisions.
机译:审查的目的本文综述了脊柱裂患儿尿路重建策略的最新进展。重建的目的是保持肾功能和实现尿失禁。关于膀胱增大,增加出口阻力的程序以及大肠口气存在很大争议。作者根据自己的个人经验对最新发表的信息进行了透视。最近的发现选择了过去5年发表的涉及上述主题的37篇论文(自2000年以来发表了25篇)。包括七个相关的较早参考。人们一直对开发扩大膀胱的方法感兴趣,这些方法避免使尿液与肠粘膜接触。人工导尿括约肌和筋膜悬带是增加出口阻力的最常报道的方法。 Mitrofanoff原理仍然被认为是构建带有附件或重新配置的肠段的大洲可导管通道的有效方法。粪便的实现必须与尿失禁同时进行。对于一小部分患者,失禁转移仍然是最好的。大陆转移尿液的作用需要重新评估。总结在这一领域继续取得进展。对该主题进行定期,批判性和客观的审查应有助于从业人员做出合理的决定。

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