Is continent urinary diversion feasible in children under five years of age?

Abstract

Purpose: To review our clinical experience with urinary continent catheterizable reservoir in children under five years of age. Materials and Methods: A total of 23 patients (16 males, 7 females) with a median age of 3.64 years were evaluated. Among these, 6 (26.08%) had a posterior urethral valve, 9 (39.13%) myelomeningocele, 4 (17.39%) bladder exstrophy, 2 (8.69%) genitourinary rabdomyosarcoma, 1 (4.34%) had spinal tumor and 1 (4.34%) an ano-rectal anomaly. Results: Perioperative complications were observed in four patients consisting of one febrile urinary tract infection, one partial operative wound dehiscence, one partial stomal dehiscence and one vesico-cutaneous fistula after a secondary exstrophy repair. The overall long-term complications rate was 40.90% and consisted of two stomal stenoses (9.09%), one neobladder mucosal extrusion (4.54%), three neobladder calculi (13.63%) and persistence of urinary incontinence in three patients (13.63%). The overall surgical revision was 36.36% and final continence rate was 95.45% with mean follow-up of 39.95 months Conclusion: Continent urinary diversion is technically feasible even in small children, with acceptable rates of complications

Bladder exstrophy: reconstructed female patients achieving normal pregnancy and delivering normal babies

“…A high percentage of women were actively working (59%) against 42.8% of our series, but persistent urinary incontinence was present in 65% of their patients and in none of ours (10). Other studies assessing continent urinary diversion found continence rates of less than 15%, more similar to our findings (25).…”

Late secondary urological reconstruction of separated ischiopagus twins with exstrophic bladder and urinary incontinence

“…Our experience with the Macedo’s technique has shown channel leakage of 13.6%. ( 14 ) The continence principle of channels in this concept is based on tube embedding over a serous-lined tunnel. We learned from previous experience that angulation of the tube over bladder dome plays a significant role to promote continence.…”

Aspectos Urológicos em Crianças com Bexiga Neurogênica: Revisão Narrativa

“…Barroso e colaboradores (2009) demonstraram que o risco de cálculo é de cerca de 10% e que parece ser um pouco maior nos pacientes com conduto cateterizável. 78 Derivações urinárias continentes podem ser necessárias em pacientes que não conseguem realizar o cateterismo via uretral ou que apresentem defeitos irreparáveis do esfíncter. 76 Os segmentos mais utilizados como mecanismos de continência são o íleo, segmento ileocecal e apêndices com taxas de sucesso de 90%.…”