Bricker Conduit for Pediatric Urinary Diversion--Should we Still Offer It?

Area of Science:

• Pediatric Urology
• Surgical Outcomes
• Renal Function Preservation

Background:

• Urinary diversion is crucial for managing complex bladder conditions in children.
• The Bricker conduit (ileal conduit) is a common urinary diversion technique.
• Long-term outcomes in pediatric patients require thorough evaluation.

Purpose of the Study:

• To assess the long-term efficacy and impact of the Bricker conduit urinary diversion in a pediatric population.
• To evaluate renal function, growth, quality of life, and complications associated with this procedure.

Main Methods:

• Retrospective review of 29 children undergoing Bricker conduit surgery between 1981 and 2011.
• Assessment of renal function using estimated glomerular filtration rate (eGFR) and analysis of growth patterns.
• Evaluation of quality of life via a dedicated questionnaire and review of hospital readmissions for complications.

Main Results:

• Neuropathic bladder was the primary indication in 72.4% of cases.
• While hydronephrosis stabilized or improved in 70.9%, 44.8% experienced worsening chronic kidney disease, and 11 developed end-stage kidney disease.
• Significant negative impacts included impaired linear growth (41.4%), poor quality of life (85%), and diversion-related complications requiring readmissions.

Conclusions:

• The Bricker conduit does not halt renal deterioration in pediatric patients.
• Significant limitations include adverse effects on growth, reduced quality of life, and a substantial rate of complications.
• Alternative strategies may be necessary for long-term renal preservation in children requiring urinary diversion.