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[Comparative results of ileal conduit and colonic conduit. Analysis of 50 children with bladder exstrophy]
Insights
For bladder exstrophy, colonic conduits showed fewer late complications than ileal conduits. Colonic conduits offer safer long-term protection for the upper urinary tract when primary closure isn't feasible.
Area of Science:
- Pediatric Surgery
- Urology
- Reconstructive Surgery
Background:
- Bladder exstrophy is a congenital condition requiring surgical intervention.
- Various surgical techniques exist, including ileal and colonic conduits, for managing bladder exstrophy when primary closure is not possible.
Purpose of the Study:
- To compare the long-term outcomes and complications of ileal conduits versus colonic conduits in children with bladder exstrophy.
- To determine the optimal surgical approach for bladder exstrophy when primary closure is not feasible.
Main Methods:
- Retrospective analysis of 50 children treated for bladder exstrophy over 20 years.
- Follow-up included clinical assessment, radiological imaging, and scintigraphy.
- Comparison of complication rates between ileal conduit (15 cases) and colonic conduit (12 cases) groups.
Main Results:
- Ileal conduits were associated with late complications requiring surgical correction, including stomatostenoses, conduit elongation, ureterointestinal anastomosis stenoses, and calculus formation.
- Colonic conduits demonstrated no late complications requiring surgery.
- A case of adenocarcinoma after ureterosigmoidostomy with a fatal outcome was noted in a separate cohort.
Conclusions:
- Colonic conduits are recommended as the preferred method for bladder exstrophy when primary closure is not possible due to small or epithelialized bladder plates.
- This approach provides superior long-term protection for the upper urinary tract.
Abstract:
During the last 20 years 50 children with exstrophy of the bladder were treated in the Department of Paediatric Surgery of the Children's Hospital of Cologne employing besides other surgical methods such as primary closure, ureterosigmoideostomy, ureterocutaneostomy etc., in 15 cases an ileal conduit and in 12 cases a colonic conduit. These children could be followed up on the average 8.5 or 3 years after the operation, clinically, roentgenologically and in some cases via scintigraphy. Late complications requiring surgical correction, such as stomatostenoses, conduit elongation, stenoses of the ureterointestinal anastomosis, calculus formation in the conduit, or complications like ureteral reflux, recurring infections of the urinary passages with pyelonephritis, occurred only with ileal conduits, whereas no late complications requiring surgery were seen with the colonic conduits. Similar results in respect of late complications were found among the patients in Munich from 1955 to 1983 with 35 exstrophies of the bladder (13 ileal conduits, 1 colonic conduit) in which additionally an adeno-carcinoma was seen after ureterosigmoideostomy with fatal outcome. Hence, we are of the opinion that the method of choice is the preparation of a colonic conduit in patients with exstrophy of the bladder where primary closure is not possible because the bladder lamina is too small or already epithelialised. This approach offers the safest possible long-term protection of the primary normally positioned upper urinary tract.