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A 22-year followup of ileal conduits in children with a neurogenic bladder
Insights
The ileal conduit in children with neurogenic bladders led to significant complications and upper tract deterioration. Newer methods are replacing it, but long-term comparisons are still needed.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Management
Background:
- Ileal conduit was historically used for urine diversion in children with neurogenic bladders.
- This aimed to prevent upper urinary tract deterioration and manage incontinence.
- However, long-term outcomes revealed high complication and deterioration rates.
Purpose of the Study:
- To evaluate long-term complications and renal deterioration in children with ileal conduits.
- To assess the incidence of upper urinary tract deterioration over extended follow-up periods.
Main Methods:
- Retrospective evaluation of 139 children with ileal conduits.
- Follow-up extended up to 22 years.
- Analysis of complication rates and upper urinary tract changes.
Main Results:
- A total of 224 complications were recorded, with 114 requiring surgical correction.
- Upper urinary tract deterioration occurred in 16.5% of 50 children followed for 10+ years (mean 13.3 years).
Conclusions:
- The ileal conduit is associated with significant long-term complications and renal deterioration in children.
- Alternative management strategies like clean intermittent catheterization and ureteral reimplantation are increasingly utilized.
- Further long-term studies are necessary to definitively compare outcomes and establish the current role of ileal conduits.
Abstract:
Previously, the ileal conduit had been used in children for diversion of urine from the neurogenic bladder to prevent deterioration of the upper urinary tracts and to manage urinary incontinence. Long-term results after ileal conduits in children have revealed upper tract deterioration and a high complication rate. The complications and renal deterioration rates in 139 children with ileal conduits followed up to 22 years were evaluated. Of 224 complications 114 required surgical correction. Upper urinary tract deterioration occurred in 16.5 per cent of 50 children followed for 10 or more years (mean 13.3 years). The ileal conduit has been replaced by clean intermittent catheterization, ureteral reimplantation for reflux, the artificial sphincter and undiversion in the management of neurogenic bladders in children. Long-term followup will be necessary to compare the results of these procedures to the known long-term results of the ileal conduit to determine the appropriate role of the ileal conduit in the management of children with neurogenic bladders.