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Experiences with bladder reconstruction in children
L R King1, G D Webster, R A Bertram
1Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
Insights
This study on bladder reconstruction in children found that opened ileal segments are effective for neurogenic bladder. Overall, 53 of 56 patients achieved continence, improving outcomes for reconstructive urology.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Continence Management
Background:
- Enterocystoplasty is a surgical procedure for bladder augmentation.
- Neurogenic bladder dysfunction affects bladder control in children.
- Various intestinal segments have been used for bladder reconstruction.
Purpose of the Study:
- To present the results of enterocystoplasty in children.
- To recommend optimal intestinal segments for different etiologies of bladder dysfunction.
- To evaluate the success rates and complications of bladder reconstruction.
Main Methods:
- Retrospective analysis of 56 children undergoing enterocystoplasty (1981-1985).
- Use of ileal, ileocecal, right colon, and sigmoid segments in tubular and opened configurations.
- Evaluation of continence, need for secondary procedures, and ureteral reimplantation success.
Main Results:
- Continence achieved in 53 of 56 patients.
- Opened ileal segments recommended for neurogenic bladder and weak anal sphincters.
- Opened ileocecal or right colon segments recommended for other etiologies.
- Successful ureteral reimplantation with normal or mildly dilated ureters.
- Modified techniques resolved initial reflux failures in ureterectasis.
Conclusions:
- Enterocystoplasty, particularly with opened ileal segments, offers favorable outcomes for bladder reconstruction in children.
- Specific intestinal segments can be tailored to patient etiology for improved success.
- Further refinement of techniques can enhance continence and manage complications effectively.
Abstract:
The results in 56 children (28 with neurogenic bladder dysfunction) undergoing enterocystoplasty between 1981 and 1985 are presented. Ileal, ileocecal, right colon and sigmoid segments were used in tubular and opened configurations. Our experience leads us to recommend opened ileal segment reconstruction in neurogenic bladder patients and those with weak anal sphincters generally, and open ileocecal or open right colon segments in patients with other etiologies. Continence was achieved in 53 patients, although secondary procedures, particularly at the bladder outlet, were required in 13. When ureteral reimplantation was required we achieved excellent success with normal-sized or mildly dilated ureters regardless of the operative technique used. Initial failures to prevent reflux in the face of marked ureterectasis using the ileocecal valve have been resolved by a modified technique of intussusception and fixation. An over-all favorable experience is reported, which we believe permits us to formulate certain rules that will improve the acceptability and success of bladder reconstruction in general.