Related Experiment Videos
[The selection of the method for urinary diversion in children]
Insights
Urinary fistulas in children with megaureter and hydronephrosis showed draining techniques were inefficient. Ureterocutaneostomy is the most reliable method for prolonged urinary diversion.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Urinary Tract Reconstruction
Context:
- Infants and children with uni- or bilateral megaureter and hydronephrosis require urinary diversion prior to reconstructive surgery.
- Ninety-five urinary fistulas were created in 62 pediatric patients aged 20 days to 13 years.
- Diversion was performed 14 days to 16 months before major reconstructive-plastic surgery.
Purpose:
- To evaluate the efficacy of draining (cystostomies, ureterostomies, nephropyelostomies) versus nondraining (ureterocutaneostomies) urinary fistula techniques.
- To compare the outcomes of different urinary diversion methods in pediatric patients.
- To identify the most reliable technique for prolonged urinary diversion in complex pediatric urological cases.
Summary:
- Draining fistula techniques were found inefficient for prolonged urinary diversion, leading to frequent infection relapses and suboptimal plastic surgery outcomes.
- Nondraining ureterocutaneostomy emerged as the most reliable and convenient method for prolonged drainage, despite requiring subsequent operations.
- Extended drainage periods of 12-16 months are recommended for deteriorating urinary tracts, particularly in younger children.
Impact:
- Findings guide the selection of optimal urinary diversion strategies in pediatric urology.
- Highlights the limitations of certain draining techniques and the advantages of ureterocutaneostomy for prolonged diversion.
- Informs clinical practice regarding the duration of urinary diversion based on urinary tract condition and patient age.
Abstract:
Ninety-five urinary fistulas have been produced at various urinary tract levels in 62 infants and children, aged 20 days to 13 years, for uni- or bilateral megaureter and hydronephrosis 14 days to 16 months prior to major reconstructive-plastic surgery. Efficacy of draining (21 cystostomies, ureterostomies and nephropyelostomies) and nondraining (74 ureterocutaneostomies) techniques was evaluated 2-6 months or later using clinical, laboratory, X-ray, tracer and urologic cinematographic studies. Fistula application and removal maneuvers and complications are described. The draining techniques were found to be inefficient in prolonged preliminary urinary diversion and to be associated with frequent infection relapses and less satisfactory results of plastic surgery. Ureterocutaneostomy proved to be the most reliable and convenient method of prolonged drainage even though it required additional operations to replace the patent ureters. The drainage should be prolonged to 12-16 months if the urinary tract deteriorates, especially in young children.