Exstrophy of the bladder--an alternative method of management

Sixteen bladder exstrophy patients were treated by diverting the urine into a non-refluxing colon conduit. There were 4 new, previously unoperated cases and 12 had been diverted earlier by ileal conduit. Subsequently, 11 conduits were detached from the abdominal wall and joined end-to-side to the rectosigmoid colon. This method has proved satisfactory to date but long-term assessment will be needed. This staged method of ureterosigmoid urinary diversion appears to be a satisfactory way to manage new patients with bladder exstrophy and patients who have been diverted previously by an ileal conduit. From our experience with non-refluxing colon conduits we conclude also that it is: 1) a better method than ileal loop for permanent diversion, 2) indicated for patients with an ileal loop who are not doing well and 3) useful in patients undergoing anterior exenteration, providing the option of joining it to the rectosigmoid if there is no recurrent disease or radiation proctitis.