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Results of urinary diversion in patients with myelomeningocele
Insights
Urinary diversion surgery in children with myelomeningocele can effectively manage incontinence and prevent further kidney damage. Ileal loop diversion is a safe and beneficial procedure for improving quality of life.
Area of Science:
- Pediatric Urology
- Neurosurgery
- Nephrology
Background:
- Myelomeningocele often leads to urinary complications including incontinence, infections, and kidney damage.
- Urinary diversion is a surgical option to manage these complex urological issues in affected children.
Purpose of the Study:
- To evaluate the long-term outcomes of urinary diversion procedures in children with myelomeningocele.
- To assess the impact of urinary diversion on renal function, urinary tract infections, and overall quality of life.
Main Methods:
- Retrospective review of 46 children with myelomeningocele who underwent urinary diversion since 1949.
- Analysis of procedure types (ileal loop, sigmoid loop, transverse colon conduit), indications, complications, and long-term follow-up data.
- Assessment of pre- and post-diversion intravenous pyelograms (IVPs) and renal function.
Main Results:
- Ileal loop diversion was the most common procedure (43/46 patients).
- Primary indications included incontinence (28), infection (27), and hydronephrosis/reflux (12).
- No perioperative deaths; low rates of early (1) and late (7) surgical revisions. 88% of patients with normal pre-diversion IVPs maintained normal or near-normal IVPs post-procedure. Renal function remained stable in all followed patients.
Conclusions:
- Urinary diversion, particularly ileal loop, is a safe and effective treatment for managing urinary issues in myelomeningocele patients.
- The procedure helps stabilize urinary tract function, prevent further renal damage, and improve patient continence and independence.
- Long-term follow-up demonstrates sustained renal function and acceptable urological outcomes in this vulnerable population.
Abstract:
Among 481 children with myelomeningocele seen at the North Carolina Baptist Hospital since 1949, 46 have undergone a urinary diversion procedure, as follows: ileal loop in 43; sigmoid loop in two; and transverse colon conduit in one. The indications for diversion were incontinence in 28, urinary infection or pyelonephritis in 27, and hydronephrosis, pyelocaliectasis, and reflux in 12 patients. No deaths resulted from the diversionary procedures. One patient required early surgical revision and seven patients required late surgical revision. Two patients have since died, 44 have been followed for an average of 7.9 years, 15 for more than 10 years. Overall, of 26 patients with normal prediversionary intravenous pyelograms (IVP's), 88% now have normal or nearly normal IVP's; of 14 patients with abnormal prediversionary IVP's, 79% now have normal, improved, or unaltered IVP's. Renal function has remained normal in all 44 patients, and renal calculi have developed in 10 patients. Ileal loop diversion appears to convert a high-pressure system into a low-pressure system, thereby helping to prevent further renal damage. This procedure tends to stabilize, rather than improve, urinary-tract function. For these children already so incapacitated by their basic disease, this goal is acceptable, particularly since it also provides continence and independence from parental nursing.