[Bladder augmentation and urinary diversion in children and adolescents]

Area of Science:

• Pediatric Urology
• Reconstructive Surgery
• Urologic Oncology

Background:

• Continent urinary diversion and bladder augmentation are rarely indicated in children and adolescents.
• Conservative management (clean intermittent catheterization and pharmacotherapy) is preferred for neurogenic bladder.
• Primary reconstruction is recommended for bladder exstrophy-epispadias complex (BEEC).

Purpose of the Study:

• To review surgical options for bladder augmentation and urinary diversion in pediatric patients.
• To discuss the advantages and disadvantages of various surgical techniques.
• To provide guidance on when these complex procedures should be considered.

Main Methods:

• Review of existing literature on surgical interventions for bladder augmentation and urinary diversion.
• Analysis of indications, techniques, and outcomes for pediatric cases.
• Discussion of patient selection criteria and management strategies.

Main Results:

• Bladder augmentation using bowel segments or ureter is an option for hyperreflexic, small, or low-compliance bladders with normal upper tracts.
• Continent cutaneous stoma is recommended for patients unable to perform clean intermittent catheterization (CIC) via the urethra.
• Continent cutaneous diversion or rectosigmoid pouch are options for specific patient groups with sphincter defects or competent anal sphincters.

Conclusions:

• Surgical options for bladder augmentation and urinary diversion are reserved for specific pediatric cases.
• Careful patient selection and consideration of alternative treatments are crucial.
• These complex procedures offer solutions for refractory bladder conditions when conservative measures fail.