Related Experiment Videos
Continent urinary diversion in childhood
T W Hensle1, J P Connor, K A Burbige
1Department of Urology, Columbia University, College of Physicians and Surgeons, New York, New York.
Insights
Continent urinary diversion offers a viable alternative for pediatric patients with complex bladder issues. This study shows high daytime continence rates and stable renal function in young individuals undergoing these procedures.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Voiding Dysfunction Management
Background:
- Continent urinary diversion is an alternative to traditional methods for managing lower urinary tract issues.
- Indications in children and young adults include bladder exstrophy, myelomeningocele, and other congenital anomalies.
Purpose of the Study:
- To evaluate the outcomes of continent urinary diversion in a pediatric and young adult population.
- To assess continence, renal function, and complication rates following various diversion techniques.
Main Methods:
- Retrospective review of 24 children and young adults who underwent continent urinary diversion.
- Procedures included Indiana pouch, Kock pouch, and Mitrofanoff principle.
- Data collected on indications, surgical techniques, continence, renal function, and complications.
Main Results:
- All 24 patients achieved daytime continence (≥4 hours dryness); 4 experienced nocturnal incontinence.
- Renal function remained stable in all patients.
- Positive urine cultures were noted in 18 patients; reoperations were required for catheterization difficulties (2) and small bowel obstruction (2).
Conclusions:
- Continent urinary diversion is a successful alternative to traditional conduit diversion in pediatric and young adult patients.
- High rates of daytime continence and stable renal function support its use.
- Careful patient selection and management of potential complications are essential.
Abstract:
We review 24 children and young adults who underwent continent urinary diversion. The indications for an operation included bladder exstrophy in 11 patients, myelomeningocele in 8, sacral agenesis in 3, cloacal anomaly in 1, and traumatic disruption of the bladder neck and urethra in 1. The operations performed included an Indiana pouch in 19 patients, including 12 whose stoma was brought to a perineal position and 7 whose stoma was placed in the anterior abdominal wall. A Kock pouch was used in 2 patients and the Mitrofanoff principle was used in 3. The particular indications for the different procedures are discussed at length. Postoperative daytime continence as defined by at least 4 hours of dryness is present in all 24 patients to date, while 4 have nocturnal incontinence. Renal function is stable in all patients to date. In 18 patients postoperative urine cultures were positive during followup. All patients are on clean intermittent catheterization and reoperation has been required in 2 relating to an inability to perform postoperative intermittent catheterization. Two patients underwent reoperation for small bowel obstruction. The series supports the use of continent urinary diversion as a viable alternative to traditional forms of conduit diversion in children and young adults.