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The effect of temporary cutaneous diversion on ultimate bladder function

V R Jayanthi1, G A McLorie, A E Khoury

  • 1Hospital for Sick Children, Toronto, Ontario, Canada.

The Journal of Urology
|August 1, 1995
PubMed
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Temporary urinary diversion in children with congenital uropathies can lead to normal bladder function after reversal. Most patients achieve spontaneous voiding, with bladder augmentation needs linked to the primary condition, not diversion itself.

Area of Science:

  • Pediatric Urology
  • Congenital Uropathies
  • Bladder Function Reconstruction

Background:

  • Congenital uropathies often necessitate urinary diversion to manage severe conditions like azotemia and hydronephrosis.
  • Temporary cutaneous diversion (vesicostomy, pyelostomy/ureterostomy) is a common surgical approach in pediatric urology.
  • Assessing the long-term impact of diversion reversal on bladder function is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate the effect of temporary urinary diversion reversal on bladder function in children with congenital uropathies.
  • To determine the rate of spontaneous voiding and need for bladder augmentation after diversion reversal.
  • To analyze factors influencing bladder recovery and the necessity for augmentation cystoplasty.

Main Methods:

Related Experiment Videos

  • Retrospective review of 75 pediatric patients undergoing diversion reversal over a 7-year period.
  • Analysis of indications for diversion, including posterior urethral valves, neurogenic bladder, and reflux.
  • Assessment of bladder function post-reversal through clinical evaluation, urodynamics, and voiding parameters.

Main Results:

  • Of 55 patients undiverted by direct closure, only 2 required later augmentation.
  • 45 of 46 patients (excluding myelomeningocele) achieved spontaneous voiding with acceptable residuals post-closure.
  • Urodynamics in 19 of 22 patients (86%) showed normal bladder capacity after direct closure.

Conclusions:

  • Temporary urinary diversion followed by reversal can restore normal bladder function in approximately 75% of children.
  • The primary congenital condition, rather than the diversion itself, appears to be the main determinant for subsequent bladder augmentation needs.
  • Direct closure following diversion reversal is highly effective in achieving functional bladder recovery.