Continent urinary undiversion to modified ureterosigmoidostomy in bladder extrophy patients

Area of Science:

• Urology
• Pediatric Surgery
• Surgical Innovation

Background:

• Urinary diversion objectives extend beyond renal preservation to include enhanced quality of life and body image.
• Continent urinary diversion is crucial for adolescents, mitigating psychological distress associated with non-continent skin stomas.
• Classic ureterosigmoidostomy, while offering daytime continence for bladder exstrophy, presents challenges like nighttime incontinence and delayed complications.

Purpose of the Study:

• To evaluate a modified continent urinary diversion technique in male bladder exstrophy patients.
• To assess the efficacy and safety of urinary undiversion to a valved rectal pouch.
• To explore the benefits of tube cecostomy and parenteral nutrition over transverse colostomy in this procedure.

Main Methods:

• Five male bladder exstrophy patients underwent urinary undiversion to modified valved rectal pouches (rectum or rectosigmoid).
• Ureters were implanted using an isolated intussusception ileal nipple valve technique.
• Tube cecostomy and total parenteral nutrition replaced temporary transverse colostomy for postoperative management.

Main Results:

• All patients achieved full daytime and nighttime urinary continence with 3-6 hour voiding intervals.
• Upper urinary tract function and configuration improved or stabilized in all renal units post-procedure.
• No clinical evidence of acidosis or symptomatic urinary tract infections was observed during the mean 19.8-month follow-up.

Conclusions:

• Modified ureterosigmoidostomy is a viable and effective option for continent urinary undiversion in bladder exstrophy, even after prior complicated procedures.
• The use of tube cecostomy and parenteral nutrition simplifies the technique and enhances patient recovery.
• This approach successfully addresses both functional and psychological aspects of urinary diversion in pediatric patients.