Current Indications and Techniques for the Use of Bowel Segments in Pediatric Urinary Tract Reconstruction

Abstract

Today, there are few indications for the use of bowel in pediatric urology. This is in large extent due to the successful conservative therapy in patients with neurogenic bladder and the improved success of primary reconstruction in patients with the bladder exstrophy-epispadias complex. Only after the failure of the maximum of conservative therapy or after failure of primary reconstruction, bladder augmentation, or urinary diversion should be considered. Malignant tumors of the lower urinary tract (e.g., rhabdomyosarcomas of the bladder/prostate) are other rare indications for urinary diversion. Replacement or reconstruction of the ureter with a bowel segment is also a quite rarely performed procedure. In this review, the advantages and disadvantages of the different options for the use of bowel segments for bladder augmentation, bladder substitution, urinary diversion, or ureter replacement during childhood and adolescence are discussed.

Engineering pedicled vascularized bladder tissue for functional bladder defect repair

“…Therapeutic options for these severe bladder diseases are limited. 25 The first clinical bladder substitution by a bowel segment can be traced back to 1913, and it has become a standard method in clinical treatment. 26 The ileum is most frequently used due to its better compliance and less contractility compared with other segments.…”

“…In urology, many conditions such as bladder cancer, neurogenic bladder, and bladder exstrophy require reconstruction. Therapeutic options for these severe bladder diseases are limited 25 . The first clinical bladder substitution by a bowel segment can be traced back to 1913, and it has become a standard method in clinical treatment 26 .…”

Paediatric kidney transplantation: Towards a framework for pretransplant urological evaluation

“…Continent anal reservoirs have been reported in cases of an irreparable urethral sphincter and a small/absent bladder (e.g. failed primary bladder closure in patients with complete bladder exstrophy) 28 Incontinent: A temporising solution for the lower urinary tract in an infant may be transplantation with concomitant vesicostomy formation until the child is of adequate size to undergo more definitive reconstruction following transplantation.…”

“…failed primary bladder closure in patients with complete bladder exstrophy). 28 • Incontinent: A temporising solution for the lower urinary tract in an infant may be transplantation with concomitant vesicostomy formation until the child is of adequate size to undergo more definitive reconstruction following transplantation. An ileal or colonic conduit may be considered primarily in patients who are not willing, or unable, to performed intermittent catheterization.…”

“…An ileal or colonic conduit may be considered primarily in patients who are not willing, or unable, to performed intermittent catheterization. 28 4. Bladder outlet procedures.…”