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Ureterorectostomy as a continent urinary diversion for complicated bladder exstrophy in children by using a modified
Mohamed A Baky Fahmy1, Abo Zid Aoud Mansour, Alaa Mazy
1Department of Pediatric Surgery, Al Azher University, Cairo, Egypt. mabfahmy@hotmail.com
Insights
This study shows a modified Duhamel technique effectively achieved urinary continence in 11 children with bladder exstrophy. The procedure, involving rectal diversion, resulted in good daytime continence with minimal complications over two years.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Reconstructive Surgery
Background:
- Urinary incontinence is a significant challenge for children with bladder exstrophy post-surgery.
- Traditional options like urinary diversion or neobladder construction have limitations.
- This study addresses the need for improved continence solutions in complex cases.
Purpose of the Study:
- To evaluate the efficacy of a modified Duhamel's rectal pouch with ureterorectostomy in children with failed bladder exstrophy repairs.
- To assess the functional outcomes and complication rates of this reconstructive technique.
Main Methods:
- Eleven children (4-7 years old) with failed bladder exstrophy repair and urinary incontinence underwent the modified Duhamel pullthrough technique.
- This involved ureteric diversion to the rectum, utilizing the anal sphincter for control.
- Patients were followed up for a mean of 24 months.
Main Results:
- No major operative or postoperative complications were observed.
- Patients achieved good daytime urinary continence, holding up to 300 ml.
- No deterioration in renal function or electrolyte balance occurred; two cases of pyelonephritis were medically managed.
Conclusions:
- The modified Duhamel technique provides effective urinary continence in children with complex bladder exstrophy.
- The procedure demonstrated a favorable safety profile with good functional outcomes over two years.
- Long-term assessment is recommended to fully understand the durability of the results.
Introduction:
Whatever the method and timing of surgery, a high proportion of children with bladder exstrophy will continue to suffer from urinary incontinence. They face the options of urinary diversion to an external stoma or construction of a neobladder from bowel. This study describes a modified Duhamel's rectal pouch with a ureterorectostomy was carried out on 11 children who had a failed repair of bladder exstrophy.
Materials And Methods:
Ten boys and one girl, aged from 4 to 7 years (mean 5.5), had several unsuccessful operations for bladder exstrophy. All selected to have good renal function and no other anomalies, but were incontinent of urine and had a small contracted or prolapsed bladder. They underwent urinary diversion to the rectum using the Duhamel pullthrough technique, where the sigmoid colon was opened into the back of the anal canal above the dentate line, creating a rectal bladder and making use of the anal sphincter to control urine and stool. All were followed up for 24 months (18-27 months).
Results:
In this selected group of patients there were no major operative or postoperative complications. Follow-up for 2 years revealed no deterioration in renal function, or electrolytes disturbance. They can hold up to 300 ml of urine and all patients are continent during the daytime with an emptying frequency of 3-5 times. Nocturnal wetting occur some 4-8 times per month with significant decrease with time. Two cases developed pyelonephritis but this was controlled with medical treatment.
Conclusion:
Eleven children achieved effective urinary continence by ureteric diversion to the rectum using a modified Duhamel pullthrough technique. Two years follow up showed no complications, except bed wetting, but long term assessment is warranted.
