Changing attitudes toward urinary dysfunction in myelodysplasia

Alternative methods to supravesical urinary diversion in myelodysplastic children, which protect the upper urinary tracts and provide urinary continence, are now available in the form of prosthetic devices and intermittent clean catheterization with or without ancillary pharmacologic agents. We believe that these alternatives deserve a trial before proceeding to supravesical urinary diversion. Short-term evaluation indicated improvements and stability in most urinary tracts treated by these methods but we recognized that, just as with the ileal conduit diversion, a longer period of followup is required before definite statements can be made about the long-term results. However, if the criteria of sterile urine and bladder emptying at physiological pressure ranges are strictly met we would suspect a favorable outcome.