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Long-term results of ureterosigmoidostomy in children with bladder exstrophy
H P Koo1, L Avolio, J W Duckett
1Division of Urology, Children's Hospital of Philadelphia, Pennsylvania, USA.
Insights
Ureterosigmoidostomy offers favorable long-term outcomes for bladder exstrophy patients, achieving high daytime continence rates. Careful monitoring for upper urinary tract changes and metabolic issues is crucial for successful management.
Area of Science:
- Urology
- Pediatric Surgery
Background:
- Bladder exstrophy is a complex congenital anomaly requiring surgical reconstruction.
- Ureterosigmoidostomy is a diversion technique used in managing bladder exstrophy, particularly in cases with small or inadequate bladder capacity.
Purpose of the Study:
- To evaluate the long-term results and outcomes of ureterosigmoidostomy in patients with bladder exstrophy.
- To assess the efficacy and safety of ureterosigmoidostomy as a urinary diversion method in this patient population.
Main Methods:
- Retrospective analysis of patients with bladder exstrophy who underwent ureterosigmoidostomy.
- Data collection included primary diversion or conversion procedures, average follow-up duration, upper urinary tract status, metabolic parameters, and continence rates.
- Biennial colonoscopies were performed for surveillance.
Main Results:
- Long-term follow-up averaged 17 years.
- Significant upper urinary tract changes occurred in 18% of patients.
- Daytime continence was achieved in 92% and nighttime continence in 58%.
- Metabolic acidosis was generally well-compensated, with rare instances of hyperammonemia.
- Benign polyps were identified and removed in 4 of 19 patients undergoing colonoscopy.
Conclusions:
- Ureterosigmoidostomy demonstrates favorable long-term outcomes in selected bladder exstrophy patients.
- Adequate imaging, metabolic surveillance, and regular colonoscopies are essential for managing potential complications.
- Ureterosigmoidostomy is presented as a viable alternative for patients with small bladders, offering good continence rates.
Purpose:
We evaluated long-term results of patients with bladder exstrophy who underwent ureterosigmoidostomy.
Materials And Methods:
Of 4 women and 23 men monitored at our institution 16 (59%) underwent primary diversion by ureterosigmoidostomy, while 11 (41%) underwent primary bladder closure or an ileal conduit procedure before conversion to ureterosigmoidostomy. Average followup after ureterosigmoidostomy was 17 years.
Results:
Significant upper urinary tract changes developed in 18% of the patients. Metabolic acidosis was well compensated in most patients but 2 had problems with urinary retention leading to hyperammonemia and acidosis. Of the 19 patients monitored with biennial colonoscopy benign polyps were removed in 4. Daytime continence was achieved in 92% of cases and nighttime continence in 58%.
Conclusions:
Our experience with ureterosigmoidostomy in children with bladder exstrophy has been favorable through long-term followup. With proper imaging, metabolic surveillance, biennial colonoscopy and nonsteroidal anti-inflammatory drugs we offer ureterosigmoidostomy as a viable alternative for patients with small bladders.