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[Bladder exstrophy: a neonatal emergency. II: Urinary diversion]
G Belloli1, P Campobasso, L Musi
1Divisione di Chirurgia Pediatrica, Sezione di Urologia, Ospedale Regionale di Vicenza, Italia.
Insights
Ureterosigmoidostomy offers an excellent long-term solution for bladder exstrophy when primary closure fails. This therapy effectively achieves urinary continence and preserves renal function, significantly improving quality of life for affected children.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Bladder Exstrophy Management
Background:
- Bladder exstrophy presents significant challenges in achieving urinary continence and preserving renal function.
- Primary bladder closure is the ideal treatment, but alternative methods are necessary when primary closure is impossible or unsuccessful.
Purpose of the Study:
- To evaluate the long-term efficacy and outcomes of ureterosigmoidostomy in selected pediatric patients with bladder exstrophy.
- To assess urinary continence, renal function, and quality of life following ureterosigmoidostomy.
Main Methods:
- A cohort of 15 pediatric patients with bladder exstrophy underwent ureterosigmoidostomy.
- Patients were followed for an average of 8 years and 9 months (range: 18 months to 19 years).
- Renal function, upper urinary tract status, fecal and urinary continence, and radiological/manometric studies were assessed.
Main Results:
- All patients maintained normal renal function.
- Upper urinary tracts were normal in 13 patients; two had moderate ureteral dilatation.
- Complete fecal and urinary continence was achieved in 13 patients; acceptable continence in two.
Conclusions:
- Ureterosigmoidostomy provides excellent long-term results for selected bladder exstrophy patients.
- Success hinges on correct patient selection, meticulous surgical technique (long submucosal tunnel, direct ureter-bowel anastomosis), and diligent post-operative care.
Abstract:
The goal of the therapy involving the children with exstrophy of bladder must include urinary continence, protection of renal function and a good quality of life. Primary closure of the bladder would seem to be the ideal solution, but when it is impossible or fails, ureterosigmoidostomy can provide satisfactory solution. We have treated 15 selected exstrophied patients with ureterosigmoidostomy. The average length of follow up was 8 years and 9 months (range is from 19 years to 18 months). All patients have normal renal function; in 13 patients upper urinary tract is normal and two have a moderate ureteral dilatation. In 13 patients the fecal and urinary continence is complete, in two it's acceptable. We report radiological and manometric studies of the rectum and sigma after ureterosigmoidostomy. The long term results are excellent; it is mandatory to have correct indications, meticulous care in the operative technique producing a long submucosal tunnel with direct anastomosis of the ureter to the bowel, post operative management and follow up care.