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Ureterosigmoidostomy: an outdated approach to bladder exstrophy?
1Department of Urology, Medical School, University of Mainz, Federal Republic of Germany.
Insights
Ureterosigmoidostomy in children offers excellent long-term continence and preserves renal function. This study shows high success rates for urinary tract reconstruction, with minimal complications in long-term follow-up.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Long-term Outcomes
Background:
- Ureterosigmoidostomy is a surgical procedure for urinary diversion.
- Indications include bladder exstrophy, epispadias, and neurogenic bladder.
- Previous reconstructions may fail, necessitating diversion.
Purpose of the Study:
- To report long-term results of ureterosigmoidostomy in pediatric patients.
- To evaluate continence rates and renal function after the procedure.
- To assess the incidence of complications, including bowel neoplasia.
Main Methods:
- Retrospective analysis of 46 children undergoing ureterosigmoidostomy.
- Follow-up averaged 14.7 years.
- Assessment of continence, renal function, and complications.
Main Results:
- 39 of 46 patients had functioning ureterosigmoidostomy at long-term follow-up.
- Daytime continence rate was 97.4%; complete continence was 92.3%.
- No renal insufficiency was observed in living patients; one tubular adenoma was successfully removed.
Conclusions:
- Ureterosigmoidostomy provides durable and effective urinary diversion in children.
- The procedure is associated with high rates of continence and preservation of renal function.
- Long-term surveillance is important for early detection of potential complications.
Abstract:
Long-term results among 46 children with ureterosigmoidostomy are presented. The indication for ureterosigmoidostomy had been bladder exstrophy in 40 patients, incontinent epispadias in 5 and neurogenic bladder dysfunction in 1. Of the 40 patients with bladder exstrophy 8 had undergone ureterosigmoidostomy after failure of other types of urinary tract reconstruction (6 had upper tract dilatation before ureterosigmoidostomy). Three patients with previously damaged upper urinary tracts required early postoperative conversion because of severely increasing kidney dilatation. Three other patients required conversion after a mean of 10 years to preserve kidney function. One patient died after 16 years of a cause not related to ureterosigmoidostomy. The remaining 39 patients were alive with a functioning ureterosigmoidostomy after a mean followup of 14.7 years. The daytime continence rate was 97.4% (38 of 39 patients) and the complete continence rate was 92.3% (36 of 39). Except for 1 tubular adenoma that was removed successfully during routine colonoscopy, no bowel neoplasia has been observed. None of the 45 living patients has renal insufficiency.