Objective: Reconstructive surgery of the lower urinary tract in children is reported with a high complication rate. The aim was to evaluate the complication rate at our institution. Material and methods: Between 2000 ...Objective: Reconstructive surgery of the lower urinary tract in children is reported with a high complication rate. The aim was to evaluate the complication rate at our institution. Material and methods: Between 2000 and 2010, 41 boys and 19 girls were consecutively operated on with augmentation with ileum (45), alternative CIC-channel (57) and bladder neck plasty (42) in isolation or as combined procedures in individuals with neurogenic bladder dysfunction NBD (42), bladder exstrophy-epispadias complex BEEC (13), isolated epispadias IE (2) and posterior urethral valves, PUV (3). Median age at surgery was 11 years (range 1.3 -21) and median follow-up time 7 years (1 -10). Complications were consecutively observed at follow-up according to a structured protocol. As first line care, specially trained nurses followed the patients and daily bladder irrigation was included in the CIC follow-up regimen. Results: In individuals with augmentation with ileum, of which all but one performed CIC through an alternative channel, there were stones reported in 3/45 (7%), perforation in 2/45 (4%), reoperation of CIC channel in 5/57 (9%), bowel obstruction in 3/56 (5%) and rupture of BNP in 3/39 (8%). Re-augmentation was not needed and malignancy not found. No significant difference was seen between patients with NBD and BEEC/IE. Conclusion: Complication rates were among the lowest reported for stones, perforation and reoperations of CIC channels and were average for bowel obstruction. Bladder stones and perforation were seen in individuals with bad compliance to recommended CIC-and irrigation regimens.展开更多
Children with urogenital malformation or bowel disturbances are a vulnerable group and are at risk of experiencing ill health. At school they have to face and cope with situations they are unused to and often feel exc...Children with urogenital malformation or bowel disturbances are a vulnerable group and are at risk of experiencing ill health. At school they have to face and cope with situations they are unused to and often feel excluded. There is a lack of studies investigating prevention of ill health in this group of children. Objective: The aim of the study was to investigate the health/well-being and self-esteem, before and after a one-year intervention comprising person-centred, web-based learning support, in preschool children born with malformations in the urethra, bladder, genitals and/or bowel. Study design: Nine boys and one girl participated, aged 3 - 7 years (study group) with diagnoses of epispadia, bladder exstrophy, urethra valves and Hirschprung’s disease. Two questionnaires were used, developed to measure index of health/wellbeing and self-esteem in younger children. In the study group, the interviews were repeated after one year. The group was compared with a control group of 20 healthy, age-matched children. Results: Before the intervention, there were no differences in wellbeing (Children condition index) between the study group and the control group. One year after the start of the web-based preschool, wellbeing in the study group had slightly improved, but not significantly compared to before the intervention. No significant difference was found compared to the control group. When measured self-esteem (I think I am) before the intervention, the study group had significantly better self-esteem compared to the control group. One year later, there was a slight improvement in self-esteem, but two children scored worse in the domain Psychological wellbeing. In comparison with the group of healthy children, the self-esteem in the study group was better for total sum (p = 0.0002). Discussion: Wellbeing and self-esteem seem to be good in children aged 3 - 7 years with uro-genital and bowel malformations, according to the findings of this study. This is better than reports concerning older children. Despite high initial values compared to healthy children, continued, but not significant, improvement in wellbeing and self-esteem was shown one year after intervention. Conclusions: The results of the intervention aimed at promoting health, wellbeing and self-esteem are promising but a longer-term follow-up in a larger group of children is needed.展开更多
文摘Objective: Reconstructive surgery of the lower urinary tract in children is reported with a high complication rate. The aim was to evaluate the complication rate at our institution. Material and methods: Between 2000 and 2010, 41 boys and 19 girls were consecutively operated on with augmentation with ileum (45), alternative CIC-channel (57) and bladder neck plasty (42) in isolation or as combined procedures in individuals with neurogenic bladder dysfunction NBD (42), bladder exstrophy-epispadias complex BEEC (13), isolated epispadias IE (2) and posterior urethral valves, PUV (3). Median age at surgery was 11 years (range 1.3 -21) and median follow-up time 7 years (1 -10). Complications were consecutively observed at follow-up according to a structured protocol. As first line care, specially trained nurses followed the patients and daily bladder irrigation was included in the CIC follow-up regimen. Results: In individuals with augmentation with ileum, of which all but one performed CIC through an alternative channel, there were stones reported in 3/45 (7%), perforation in 2/45 (4%), reoperation of CIC channel in 5/57 (9%), bowel obstruction in 3/56 (5%) and rupture of BNP in 3/39 (8%). Re-augmentation was not needed and malignancy not found. No significant difference was seen between patients with NBD and BEEC/IE. Conclusion: Complication rates were among the lowest reported for stones, perforation and reoperations of CIC channels and were average for bowel obstruction. Bladder stones and perforation were seen in individuals with bad compliance to recommended CIC-and irrigation regimens.
文摘Children with urogenital malformation or bowel disturbances are a vulnerable group and are at risk of experiencing ill health. At school they have to face and cope with situations they are unused to and often feel excluded. There is a lack of studies investigating prevention of ill health in this group of children. Objective: The aim of the study was to investigate the health/well-being and self-esteem, before and after a one-year intervention comprising person-centred, web-based learning support, in preschool children born with malformations in the urethra, bladder, genitals and/or bowel. Study design: Nine boys and one girl participated, aged 3 - 7 years (study group) with diagnoses of epispadia, bladder exstrophy, urethra valves and Hirschprung’s disease. Two questionnaires were used, developed to measure index of health/wellbeing and self-esteem in younger children. In the study group, the interviews were repeated after one year. The group was compared with a control group of 20 healthy, age-matched children. Results: Before the intervention, there were no differences in wellbeing (Children condition index) between the study group and the control group. One year after the start of the web-based preschool, wellbeing in the study group had slightly improved, but not significantly compared to before the intervention. No significant difference was found compared to the control group. When measured self-esteem (I think I am) before the intervention, the study group had significantly better self-esteem compared to the control group. One year later, there was a slight improvement in self-esteem, but two children scored worse in the domain Psychological wellbeing. In comparison with the group of healthy children, the self-esteem in the study group was better for total sum (p = 0.0002). Discussion: Wellbeing and self-esteem seem to be good in children aged 3 - 7 years with uro-genital and bowel malformations, according to the findings of this study. This is better than reports concerning older children. Despite high initial values compared to healthy children, continued, but not significant, improvement in wellbeing and self-esteem was shown one year after intervention. Conclusions: The results of the intervention aimed at promoting health, wellbeing and self-esteem are promising but a longer-term follow-up in a larger group of children is needed.
