Urinary diversion in children

At the present time, urinary diversion in children remains an last resort type of treatment that must be carried out in selected cases when there is no alternative available. All forms of urinary diversion have the common goal of gaining control of a life-threatening situation; all, however, are fraught with serious disadvantages for the affected children. The newer forms (undiversion, pouch, ileocystoplasty, augmentation) undoubtedly improve the patient's quality of life, but the risks of long-term metabolic and renal complications and malignant degeneration persist. Harzmann, who for years has concerned himself with urinary diversion and, in particular, with malignant changes, has posed two difficult questions: 1. Is urinary diversion using bowel segments defensible for benign disorders, e.g., in children? 2. Which follow-up examinations should be performed after urinary diversion using bowel segments, and at what time intervals? Our goal should be to keep the number of urinary diversions as small as possible by means of appropriate treatment, prophylaxis, and in particular the means and type of primary reconstructive therapy. Children have a life-time ahead of them, and the complications of urinary diversion increase decade by decade. This fact has been demonstrated in children who have undergone ureterosigmoidostomy or ileal conduit. Grounds for the assumption that fewer serious long-term complications are to be expected after colon conduit, pouch, neobladder, or augmentation procedures have not been established.