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Blasenekstrophie

Qualität der Primärversorgung und Langzeitprognose

Bladder exstrophy

Quality of primary care and long-term prognosis

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Zusammenfassung

Hintergrund

Der initial schonende und erfolgreiche Verschluss einer Blasenekstrophie ist für die langfristige Prognose entscheidend. Nicht zuletzt aus Mangel an vergleichbaren multizentrischen Studien existieren weiterhin unterschiedliche Rekonstruktionskonzepte, ohne dass dafür jeweils evidenzbasierte Grundlagen vorliegen.

Diskussion

Das von uns derzeit favorisierte Konzept einer zeitverzögerten („delayed procedure“) und geplant zweiaktigen Rekonstruktion („staged procedure“) ohne Osteotomie der klassischen Blasenekstrophie wird anhand der aktuellen Literatur, insbesondere zu Langzeitstudien, sowie der eigenen klinischen und basiswissenschaftlichen Daten aus den letzten Jahren begründet und zur Diskussion gestellt.

Schlussfolgerung

Der zeitverzögerte Verschluss hat gegenüber der Operation im Neugeborenenalter v. a. zahlreiche medizinische aber auch psychologische Vorteile. Bislang gibt es keine Daten, die eindeutig Vorteile durch den zusätzlich belastenden Eingriff der Osteotomie belegen. Möglicherweise hat die initiale Blasenhalsplastik durch die widerstandsbedingte intravesikale Druckerhöhung eher schädigende Auswirkungen auf die Entwicklung der Blase und auf den oberen Harntrakt.

Abstract

Background

It is universally agreed that successful and gentle initial bladder closure is decisive for favorable long-term outcome. Due to a number of reasons, including a lack of comparable multicenter studies, there are numerous concepts for initial exstrophy closure.

Discussion

Therefore, we describe our concept of delayed, staged reconstruction without osteotomy in classical bladder exstrophy, while taking into considerion the available literature on long-term follow-up as well as on own clinical and research data.

Conclusion

Most notably there are multiple medical but also psychological advantages of a delayed procedure. Primary closure without osteotomy is feasible and has no disadvantages in the long-term follow-up when compared to the invasive procedure of osteotomy. Due to high intravesical pressure, initial bladder neck surgery might have negative effects on bladder development and on the upper urinary tract.

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Authors and Affiliations

  1. Klinik für Kinderurologie in Kooperation mit der Universität Regensburg, Klinik St. Hedwig Regensburg, Steinmetzstr. 1–3, 93049, Regensburg, Deutschland

    W. H. Rösch FEAPU & M. Promm

Authors
  1. W. H. Rösch FEAPU
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  2. M. Promm
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Correspondence to W. H. Rösch FEAPU.

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Interessenkonflikt

W.H. Rösch und M. Promm geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Rösch, W.H., Promm, M. Blasenekstrophie. Urologe 55, 53–57 (2016). https://doi.org/10.1007/s00120-015-0010-4

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