Long-term Results of Ileal Conduit Diversion in Children-A Brighter Picture?

Graham, Andrew G.

doi:10.1111/j.1464-410x.1982.tb13612.x

Cited by 19 publications

(10 citation statements)

References 11 publications

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“…However, the number of reported complications increased with the duration of follow-up. Deterioration of the upper urinary tract and renal function, calculi formation and stoma stenosis resulted in a late complication rate between 19-86% [3,4,5,6,7]. In the 1970s, Hendren and Middleton concluded that this operation should be abandoned in children or any patient with potential longevity [5,8].…”

Section: Introductionmentioning

confidence: 95%

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Urinary diversion in children and adolescents with neurogenic bladder: the Mainz experience

Stein¹,

Wiesner²,

Beetz³

et al. 2005

Pediatr Nephrol

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After the failure of conservative treatment of neurogenic bladders, urinary diversion has to be considered. For patients with chronic renal failure, severe dilated upper urinary tracts with deterioration of the renal function and those who are not able to perform a self-catheterization, the colonic conduit diversion is our therapy of choice. In this part of the study, we investigate the long-term safety of our concept for these patients in regard to protecting the upper urinary tracts. Between 1968 and 2002, colonic conduit urinary diversion was performed in 88 patients, in most of them in the era before continent diversion. Overall, 11 patients with a colonic conduit were converted to bladder substitution or continent cutaneous diversion during the follow-up period. These patients are no longer included in the long-term follow-up of colonic conduit patients. Of the 77 patients with colonic conduit diversion, 21 patients were not available for follow-up: 11 were deceased and 10 were lost to follow-up. Three of the deaths were related to nephrological complications in patients who already had impaired renal function before conduit diversion. An average follow-up of 21.8 years (2-32.7; median 23.8 years.) is available in 56 patients with 99 RUs (6 solitary kidneys, 7 nephrectomies). Five non-functioning kidneys were removed after recurrent pyelonephritis and two kidneys with pyonephrosis. Ureter stenoses were corrected in 6% of the RUs. As compared to preoperatively, the upper urinary tracts remained stable or improved in 97/99 RUs at the latest follow-up. A revision of the stoma was necessary in 16% (conduit elongation n =2, stenosis n =7) and calculi formations were treated in 8% of the RUs. For patients with chronic renal failure or who are unable to perform a catheterization of a continent stoma, the colonic conduit is a safe alternative in the long run.

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Section: Introductionmentioning

confidence: 95%

“…Calculi developed in eight RUs (8%) after a mean of 7.6 years (range, [3][4][5][6][7][8][9][10][11][12][13][14]. Open stone surgery was performed in five patients before the era of extracorporal shock wave lithotripsy (ESWL), while two others underwent ESWL.…”

Section: Upper Urinary Tractmentioning

confidence: 99%

Urinary diversion in children and adolescents with neurogenic bladder: the Mainz experience

Stein¹,

Wiesner²,

Beetz³

et al. 2005

Pediatr Nephrol

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“…Nach einer medianen Nachbeobachtungszeit von nunmehr 23 Jahren waren bei 98% der 102 renalen Einheiten die Abflussverhältnisse des oberen Harntraktes unverändert oder im Vergleich zum prä-operativen Befund verbessert,die Reoperationsrate lag bei 33%.Danach ist das Colon-Conduit bei Kindern dem Ileum-Conduit mit einer Komplikationsrate von 19-86% überlegen und sollte im Falle einer temporären oder permanenten inkontinenten Harnableitung bevorzugt verwendet werden [35,36,37,38]. …”

Section: Colon-conduitunclassified

Kinder und Jugendliche mit neurogener Blasenfunktionsst�rung

2004

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After the failure of conservative treatment in patients with neurogenic bladders, urinary diversion is a viable compromise between the urologist's concerns and the patient's desire, as the upper urinary tract can be protected in the long-term and high continence rates can be provided. This can be achieved with an acceptable complication rate. Our indications for orthotopic bladder augmentation or substitution involve patients with a good orthopedic condition and mobility, who find it easy to perform CISC through the urethra. A continent umbilical stoma offers a good alternative in obese, immobile or wheelchair bound patients. The serous lined extramural tunnel technique has proven to be superior to submucosal implantation in patients with fibrotic and dilated ureters.

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“…For the subsequent three decades, the use of ileal or non‐refluxing colon conduits and ureterosigmoidostomy reigned supreme. However, in the early 1980s, these operations “fell from grace” when 20‐year follow‐up data showed significant deterioration of the upper tracts to occur in up to 80% of patients with these reconstructive techniques . In addition to the increased risk of renal injury was the eventual finding that 30 years after a ureterosigmoidostomy, an average of 15% of patients had developed an adenocarcinoma, and another 25% had developed a benign adenomatous colonic polyp, either adjacent to or at the site of the ureteroenteric anastomosis .…”

Section: Introductionmentioning

confidence: 99%

“…Also, it was believed that the routine use of operations that would allow for urinary continence would provide a significant psychological benefit to this patient population . Subsequently, in the early 1980s, there was a public outcry to universally abandon the use of urinary conduits and ureterosigmoidostomy as reconstructive surgical techniques in children . Indeed, it became in vogue, to “undivert” children with urinary conduits to bladder augmentations or continent reservoirs to prevent the unfavorable physical and psychological complications of urinary conduits …”

Section: Introductionmentioning

confidence: 99%

Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: Incidence and management of the non‐lethal complications of bladder augmentation

Husmann

2017

Int J of Urology

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The present review provides clinical insights and makes recommendations regarding patient management garnered by the long-term follow up of patients undergoing enteric bladder augmentation for the management of congenital anomalies. A prospectively maintained database on 385 patients that have experienced an enteric bladder augmentation, using either the ileum or colon, was reviewed. Evaluations included methods used to prevent bladder calculi formation and recurrence, the incidence and etiology of renal calculi development, the incidence and treatment of vitamin B 12 deficiency, and the complications and need for surgical revisions for continent catheterizable stomas. A significantly increased risk for continent catheterizable stomal complications occurred after Monti-Yang tube formation, 70% (21/ 30 patients), compared with appendicovesicostomy, 41% (27/66 patients), P = 0.008. Both procedures had significantly more complications than continent catheterizable stomas using tapered ileum with a reinforced ileal-cecal valve, 21% (13/63 patients), P < 0.0001 and P < 0.013, respectively. Approximately 50% of the patient population developed a body mass index ≥30 during adulthood. The onset of obesity resulted in significantly more complications developing in patients with a Monti-Yang tube (87%; 13/ 15 patients) or appendicovesicostomy (55%; 18/33 patients) compared with a tapered ileum with a reinforced ileal-cecal valve (27%, 8/30 patients), P < 0.00015 and P < 0.025, respectively, with a median follow-up interval of 16 years, range 10-25 years. Long-term follow-up evaluations on patients undergoing an enteric bladder augmentation are necessary to prevent the long-term sequela of this procedure. The key to improving patient prognosis is the nutritional management of the patient as they mature, especially if a continent abdominal stoma is going to be carried out.

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Long-term Results of Ileal Conduit Diversion in Children-A Brighter Picture?

Cited by 19 publications

References 11 publications

Urinary diversion in children and adolescents with neurogenic bladder: the Mainz experience

Urinary diversion in children and adolescents with neurogenic bladder: the Mainz experience

Kinder und Jugendliche mit neurogener Blasenfunktionsst�rung

Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: Incidence and management of the non‐lethal complications of bladder augmentation

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