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Related Experiment Videos

Continent urinary diversion and the exstrophy-epispadias complex.

Ilhami Surer1, Fernando A Ferrer, Linda A Baker

  • 1Division of Pediatric Urology, Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA.

The Journal of Urology
|February 11, 2003
PubMed
Summary

Continent urinary diversion significantly increases bladder capacity and achieves high continence rates in exstrophy-epispadias patients. Long-term complications include bladder stones and stomal stenosis, requiring careful management.

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Area of Science:

  • Urology
  • Pediatric Surgery
  • Reconstructive Surgery

Background:

  • Continent urinary reservoirs are crucial for urinary reconstruction in children with small or neuropathic bladders.
  • Augmentation cystoplasty combined with clean intermittent catheterization can achieve bladder continence and preserve renal function.
  • Creating a continent cutaneous stoma is a challenging aspect of these procedures.

Purpose of the Study:

  • To analyze the complications and long-term results of continent urinary diversion in patients with exstrophy-epispadias.

Main Methods:

  • Retrospective review of 704 exstrophy-epispadias cases.
  • Identification of 91 patients who underwent continent urinary reservoir creation.
  • Chart review for diagnosis, augmentation technique, continence mechanism, age, bladder capacity, continence status, and complications.

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Main Results:

  • 93% of patients achieved continence with clean intermittent catheterization via stoma.
  • Mean postoperative bladder capacity increased significantly (524%).
  • Most common complications were bladder stone formation (26%) and stomal stenosis (23%).

Conclusions:

  • Augmentation and continent diversion effectively increase bladder capacity and continence in exstrophy-epispadias patients, preserving renal function.
  • Bladder calculi and stomal stenosis are the primary long-term complications.
  • These procedures offer a viable solution for managing complex bladder conditions.