Bladder replacement in children and young adults

Our experience with total and subtotal bladder replacement in 23 patients is reviewed. The patients were divided into 3 categories, depending upon how much functional bladder, bladder neck or urethra was present at the time of reconstruction. The general indications for operation were urinary incontinence in 13 cases and prior urinary diversion in 10. Bladder reconstruction was performed using a segment of the right colon in 18 patients and the left colon in 5. Renal function has remained stable in 20 patients, deteriorated in 2 and improved in 1. Of the patients 14 are dry day and night (8 on clean intermittent catheterization and 2 with an artificial urinary sphincter), 7 are dry by day and wet at night, and 2 are wet day and night. Of the 23 patients 15 experienced a postoperative complication, the most common of which was loss of the antireflux ileocecal mechanism in 8. Bladder replacement with an isolated bowel segment is feasible in properly selected patients. Our series illustrates many of the areas of consideration in total and subtotal bladder replacement.