[Urinary diversion in childhood: special attention to the long-term consequences and complications]

Area of Science:

• Urology
• Gastroenterology
• Oncology

Context:

• Bowel segments are widely utilized for urinary tract reconstruction, including bladder augmentation and various forms of urinary diversion (continent/incontinent).
• The rectosigmoid pouch presents a viable option for patients with a competent anal sphincter and normal renal function.
• Urinary diversion in pediatric patients often involves those with dilated upper urinary tracts, leading to higher complication and reoperation rates (up to 42%).

Purpose:

• To review the use of bowel segments in urinary tract reconstruction.
• To highlight the specific complications associated with different bowel segments used in urological procedures.
• To emphasize the long-term surveillance requirements for patients undergoing these reconstructive surgeries.

Summary:

• Ileal and colonic segments are commonly employed for bladder augmentation and urinary diversion.
• Metabolic consequences, such as acid-base imbalance, vitamin malabsorption, and bile acid-induced diarrhea, can arise from incorporating bowel segments.
• Specific complications are inherent to each bowel segment used, requiring careful consideration.

Impact:

• Highlights the metabolic and oncological risks associated with using bowel segments for urinary tract reconstruction.
• Underscores the critical need for lifelong patient surveillance, particularly for continent urinary diversion and bladder augmentation.
• Informs clinical practice regarding the selection of bowel segments and long-term management strategies in urological reconstruction.