Urinary undiversion in adults

At our medical center 7 adult patients with various types of urinary diversion have undergone total reconstruction during a 3-year period. Followup has ranged from 12 to 36 months. Initial pathological conditions included 3 patients with obstruction, 3 with myelodysplasia and associated incontinence, and 1 with massive vesicoureteral reflux. Thorough radiologic, endoscopic and urodynamic evaluation, as well as physiologic testing after vesical hydrodistension, allows careful preoperative selection of reconstruction candidates. Followup studies, including excretory urography and voiding cystourethrography at 3 and 12 months, as well as monthly urine cultures during the first year, have shown that 5 of the 7 patients (71 per cent) are free of vesicoureteral reflux. Two patients have persistent reflux after reconstruction and sterile urine cultures on antibiotic suppression. Renal function has been maintained in 5 of the 7 reconstructed patients (71 per cent) and social continence has been achieved in all 7, including 3 who have achieved social continence by means of clean intermittent catheterization.