小児神経因性膀胱における尿管皮膚移植術

Abstract

Urinary diversion in children requires to be fitted with a good collection device without an indwelling catheter. For permanent supravesical urinary diversion in patient with normal ureters, it is best done with an ileal conduit or, in selected patients, with ureterosigmoidostomy. When the ureters are dilated and have peristalsis, cutaneous ureterostomy through a single stoma is the procedure of choice. For last three years we have performed cutaneous ureterostomy on 10 children. These included several with impaired renal function. Of these, 9 patients had neurogenic bladder associated with spinal meningomyelocele and one patient had neurogenic damage from rectoplasty for imperforate anus. In the operative procedure, course of the ureters was extraperitoneal with midline nipple stoma in 6 patients and transperitoneal (Straffon's method) in 4 patients. Postoperative excretory urograms revealed that 45 % of renal units had improved, 25 % of renal units had remained unchanged and 30 % had deteriorated. Postoperative values of BUN and serum creatinine were within normal limits in most of the cases. PSP test, Fishberg test and creatinine clearance had improved but they were not satisfactory. Urinary tract infection had persisted in most of the cases. The complication encountered in this series was stomal stenosis in 5 ureters due to necrosis of the ureteral end. There was no significant difference between extra peritoneal method and Straffon's method as far as postoperative evaluation is concerned, but we believe that Straffon's method has an advantage of avoiding complications.