Undiversion in children with renal failure

Four children with moderate and 9 with severe chronic renal failure and cutaneous ureterostomies or vesicostomies underwent undiversion to facilitate the eradication of urinary tract infection, reestablish bladder function, and to avoid ablating posterior urethral valves in a dry urethra. This allowed for proper preparation for renal transplantation. In addition, for the less severe cases for whom renal transplantation was more remote, the psychosocial benefits of undiversion were equally important. There were three complications that were easily managed. In four cases of moderate chronic renal failure and in seven cases of severe renal failure not requiring hemodialysis, there was no deterioration of renal function following undiversion. Two patients were on hemodialysis prior to undiversion. The urinary tract became sterile in 12 patients. These preliminary results suggest that chronic renal failure is not a contraindication for urinary undiversion and that this procedure may facilitate future management of the patient, including renal transplantation.