THÔNG TIN TÀI LIỆU
necessitates a workup for pyelonephritis Stomal stenosis can also lead to the formation of urinary calculi In this setting, surgical revision of the ileal stoma must be undertaken Urinary Undiversions As the child with a vesicostomy or ileal loop grows older, the social stigma of a diaper motivates many of these patients to seek urinary continence For patients with spina bifida or exstrophy, this goal may be achieved by the use of an intestinal segment to augment bladder capacity (enterocystoplasty) In addition, a procedure to tighten the bladder neck and create resistance to leakage and creation of a channel through which the patient can perform intermittent catheterization is indicated For all patients with spina bifida and most patients with exstrophy, continence comes at the expense of daily clean intermittent catheterization (CIC) for the rest of their lives Careful patient and family selection is necessary for this procedure; compliance with CIC is crucial Nevertheless, the enhanced self-esteem and improved quality of life these patients report are gratifying Perforation is the worst complication of intestinal augmentations to create neobladders Most bladder perforations result from overdistention of the augmented bladder, which then diminishes perfusion to the bowel segment In addition, the urine in these neobladders is chronically colonized because of the use of intermittent catheterization Patients may present anywhere from month to many years after surgery with a history of acute abdominal pain Fever may be present within a few hours of perforation Because many patients with spina bifida have decreased or absent abdominal sensation, peritonitis may be fairly advanced before pain is experienced The presence of abdominal pain in a patient with a urinary diversion should prompt an immediate call to the patient’s urologist The urologic evaluation generally consists of a fluoroscopic gravity cystogram with views during filling and emptying, or a CT cystogram Small perforations may be obscured with the full bladder and become apparent only during bladder emptying Prophylactic antibiotics should be administered before the cystogram Once this diagnosis is established, the patient should be prepared for emergency laparotomy Patients may present to the ED with a sudden inability to pass a catheter into their neobladder This situation may be because the appendiceal conduit through which they pass their catheter contains a false passage A fluoroscopic study is warranted to delineate the passage and allow catheterization under radiographic control The same situation is often true for patients catheterizing per urethra In
Ngày đăng: 22/10/2022, 21:03
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