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Continent cutaneous urinary diversion in children: experience with Charleston pouch I
N K Bissada1, M M Abdallah, I Aaronson
1Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Insights
The Charleston pouch I continent urinary diversion is a satisfactory option for children, offering good continence and upper urinary tract preservation. Patient and family acceptance were favorable, with acceptable complication rates.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Urinary Diversion Techniques
Background:
- Complete continent urinary diversion excluding the bladder is infrequently performed in pediatric cases.
- The Charleston pouch I is a specific type of continent cutaneous urinary diversion.
- Evaluating outcomes is crucial for establishing its utility in children.
Purpose of the Study:
- To assess the short-term and long-term outcomes of the Charleston pouch I continent cutaneous urinary diversion in pediatric patients.
- To determine the efficacy, safety, and patient acceptance of this diversion method.
Main Methods:
- A retrospective review of 17 children who underwent Charleston pouch I diversion between 1988 and 2005.
- Data collected included patient demographics, indications, pre- and post-operative parameters, continence, complications, and long-term functional status.
- Mean follow-up was 87.5 months.
Main Results:
- Indications included bladder exstrophy (47%), neurogenic bladder (35%), and cloacal abnormalities (18%).
- Most patients achieved dryness with catheterization every 2-6 hours; leakage occurred with missed catheterizations.
- No upper urinary tract deterioration or clinical pyelonephritis/acidosis was observed; 18% developed bladder stones. Patient and family acceptance was satisfactory.
Conclusions:
- Charleston pouch I continent urinary diversion is a satisfactory procedure in children.
- It effectively preserves the upper urinary tract and achieves acceptable continence.
- Good patient/parent acceptance and acceptable complication rates support its use.
Purpose:
Complete continent urinary diversion not incorporating the bladder is not commonly used in children. We evaluated the short and long-term outcome of a form of continent cutaneous urinary diversion (Charleston pouch I) in children.
Materials And Methods:
A total of 17 children underwent Charleston pouch I continent cutaneous urinary diversion between 1988 and 2005. Patient records were reviewed for age, sex, indications for diversion, preoperative and postoperative laboratory and radiological studies, continence, patient and family acceptance, complications and long-term functional status.
Results:
Patient age ranged from 6 to 16 years. The main indication for diversion was bladder exstrophy in 8 patients (47%), neurogenic bladder in 6 (35%) and cloacal abnormalities in 3 (18%). Mean followup was 87.5 months. One patient was lost to followup. With moderate fluid intake the other patients were dry with a mean catheterizing time of 3.4 hours (range 2 to 6). Catheterization intervals were adjusted for individual patients. Generally, the patients became damp or leaked if they did not catheterize at recommended intervals. Continence was achieved at variable postoperative intervals, with some patients attaining continence soon after and others at 3 to 12 months before pouch maturation. Patients irrigated the pouch a mean of 4 times weekly (range 0 to 14). Three patients (18%) had bladder stones. Ultrasound and/or other upper tract studies revealed no deterioration of the upper urinary system. No patient experienced clinical pyelonephritis or acidosis. Family and patient acceptance was satisfactory.
Conclusions:
Continent cutaneous urinary diversion with Charleston pouch I was satisfactory in this group of children. It provided preservation of the upper urinary tract, and achieved acceptable continence rates while allowing leakage when catheterization was not performed at recommended intervals. In addition, patient and parent acceptance was good, and complication rates were acceptable.
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