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The social implications of lower urinary tract reconstruction performed during childhood
1Department of Paediatric Urology, Wessex Regional Centre for Paediatric Surgery, Southampton General Hospital, UK.
Insights
Pediatric patients undergoing urinary diversion, undiversion, or bladder reconstruction experienced better social outcomes with undiversion and reconstruction. These procedures improved quality of life compared to urinary diversion, despite higher re-operation rates.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Quality of Life Research
Background:
- Childhood urinary tract conditions often necessitate surgical interventions like urinary diversion, undiversion, or bladder reconstruction.
- Evaluating the long-term social impact of these pediatric surgeries is crucial for patient well-being.
Purpose of the Study:
- To compare the social effects of three surgical approaches: urinary diversion, undiversion, and orthotopic bladder reconstruction in children.
- To assess patient satisfaction and functional outcomes across different surgical management strategies.
Main Methods:
- A cohort of 99 pediatric patients treated between 1960 and 1993 were interviewed using a standardized questionnaire.
- Data collected included surgical type, outcomes, medical support, and social effects (employment, schooling, independence, body image, social interactions).
Main Results:
- Both undiversion and bladder reconstruction groups reported higher patient satisfaction and better social outcomes compared to the urinary diversion group.
- Continence rates were comparable across groups, but re-operation rates were higher in the reconstruction and undiversion groups.
- Social effects, including employment, schooling, and independence, were notably improved in patients who underwent undiversion or bladder reconstruction.
Conclusions:
- Undiversion and orthotopic bladder reconstruction offer superior social outcomes for pediatric patients compared to urinary diversion.
- Despite higher re-operation rates, these procedures enhance quality of life, underscoring the importance of specialized urological nursing care.
Objective:
To compare the social effects of urinary diversion, undiversion and orthotopic bladder reconstruction performed during childhood.
Patients And Methods:
Of 99 patients treated at the Wessex Centre for Paediatric Surgery between 1960 and 1993, 46 (16 with a urinary diversion, eight with an undiversion and 22 with bladder reconstruction) were interviewed using a standardized questionnaire. Information was collected about the types and results of surgery, the medical support received and the social effects of the different treatments.
Results:
By day, continence or only occasional wetting was achieved in 13 patients with diversions, all those with undiversions and 16 of those with reconstructions. At night, 13 patients with diversions, seven with undiversions and 18 with reconstructions were dry or only occasionally wet. Re-operation rates were higher in those with reconstruction and undiversion. Only five of the diversion group were satisfied with their management compared to all patients in the other two groups. The social effects in terms of employment, schooling, independence, body image and social interactions were also better in those with undiversions and reconstructions.
Conclusions:
The social effects of undiversion and bladder reconstruction were better than those following urinary diversion despite the higher re-operation rates and the need for a rigid regimen of post-operative care. However, the need for continuing medical support in this group of patients cannot be over emphasized, and the vital role of the urological nurse specialist is stressed.