Seven years' experience of ureterosigmoidostomy in surgically failed exstrophy of the bladder

Reconstruction of a typical exstrophy of bladder and to achieve normal or nearly normal functional activity is still in investigating stage. In spite of efforts of many surgeons satisfactory results are too far to be obtained and it is almost impossible to obtain a near normal bladder capacity with full continence, free of infection and non-obstructive to the upper urinary tracts. Six cases of exstrophy of bladder where reconstruction has failed several times were subsequently referred to the urology department of Calcutta National Medical College, Calcutta, for urinary diversion; on one case previous attempt at repair resulted in small thick walled bladder with recurrent calculus formation. This study was made on those 6 patients, their age ranging from 3 to 14 years, in whom ureterosigmoidostomy was carried out during the year 1979 to 1986. In all patients careful bowel preparation was carried out by low residue diet, laxatives, enemas and antibiotics. Two patients developed hyperchloraemia and acidosis, 2 pyelonephritis and 2 remained asymptomatic till December 1986. None of those patients died so far. Ureterosigmoidostomy is not ideal but it can be adequate and sometimes is the preferred form of urinary diversion within limited resources. None of the methods of urinary diversion are free from complications but considering all, ureterosigmoidostomy as a method of urinary diversion is non-hazardous simple procedure with practically no mortality.(ABSTRACT TRUNCATED AT 250 WORDS)