Continent urinary reservoir in exstrophy/epispadias complex

Area of Science:

• Urology
• Pediatric Surgery
• Reconstructive Surgery

Background:

• Bladder exstrophy and epispadias complex present significant challenges in urinary management.
• Traditional urinary diversions can lead to incontinence and renal complications.
• Reconstruction of continent urinary reservoirs (CUR) offers an alternative approach.

Purpose of the Study:

• To evaluate the outcomes of continent urinary reservoirs (CUR) in pediatric patients.
• To assess the efficacy of CUR in managing bladder exstrophy and epispadias complex.
• To determine the long-term continence and renal function following CUR.

Main Methods:

• Retrospective review of 15 pediatric patients undergoing CUR reconstruction between 1987 and 1990.
• Procedures included Indiana pouch (10 patients) and Mitrofanoff procedure (5 patients) using various bowel segments.
• Analysis of continence, renal function, and complications.

Main Results:

• All 15 patients achieved continence with clean intermittent catheterization.
• Stable renal function was maintained in all patients.
• Three patients developed reservoir stones requiring open cystolithotomy.

Conclusions:

• Continent urinary reservoirs are an effective alternative to traditional urinary diversion for selected patients.
• CUR procedures provide durable continence and preserve renal function in the management of bladder exstrophy/epispadias complex.
• Careful patient selection and surgical technique are crucial for successful outcomes.