Related Experiment Videos
Isolated vesicorectal internal urinary diversion: a 37-year review of the Boyce-Vest procedure
1Division of Pediatric, Adolescent and Reconstructive Urology, Bowman Gray School of Medicine of Wake Forest University, Winston Salem, North Carolina.
Insights
Managing bladder exstrophy in children remains challenging. A 37-year study shows a colostomy with bladder-rectal anastomosis offers effective urinary continence and preserves kidney function.
Area of Science:
- Pediatric Urology
- Surgical Management of Congenital Anomalies
Background:
- Bladder exstrophy presents significant surgical challenges in pediatric urology.
- Despite extensive research, a consistently satisfactory method for achieving urinary continence in affected children has not been established.
Purpose of the Study:
- To review a 37-year clinical experience with a specific urinary diversion technique for bladder exstrophy.
- To evaluate the long-term efficacy of this method in achieving urinary continence and preserving renal function.
Main Methods:
- Neonatal closure of the exstrophic bladder is recommended for infants.
- In cases where other continence methods fail and anal continence is present, a diverting colostomy with bladder-rectal anastomosis was employed.
Main Results:
- The described urinary diversion technique provides sphincteric urinary continence.
- This approach demonstrates excellent long-term preservation of renal function and upper urinary tract anatomy.
- Neonatal closure followed by later attempts at continence establishment appears optimal for infants.
Conclusions:
- A diverting colostomy combined with isolated bladder-to-rectal stump anastomosis is an acceptable long-term urinary diversion option for bladder exstrophy.
- This method offers sphincteric urinary continence with relative protection against upper urinary tract deterioration.
- Early bladder closure is advised, with continence management addressed later in childhood.
Abstract:
The challenges that management of exstrophy of the bladder pose the pediatric urological surgeon have resulted in a multitude of ingenious operations and a voluminous literature on exstrophy. Despite this intense interest in an uncommon anomaly, no consistently satisfactory approach to achieve urinary continence in children with exstrophy has evolved. We summarize a 37-year clinical experience with a form of urinary diversion that provides sphincteric urinary continence, and unexcelled long-term preservation of renal function and upper urinary anatomy. From our review it appears that the infant with exstrophy is served best by neonatal closure of the exstrophic bladder with attempts to establish urinary continence later in childhood. When other methods to establish urinary continence are unsuccessful and satisfactory anal continence has been demonstrated, a diverting colostomy combined with anastomosis of the isolated bladder to the isolated rectal stump offers an acceptable long-term alternate form of urinary diversion to produce sphincteric urinary continence with relative freedom from upper urinary deterioration.