Urinary Diversion and Orthotopic Bladder Substitution in Children and Young Adults With Neurogenic Bladder: A Safe Option for Treatment?

Abstract

After failure of conservative treatment in patients with neurogenic bladder urinary diversion represents a safe long-term compromise. Daytime and nighttime continence is provided by the Mainz pouch bladder substitution and urinary diversion, while the upper urinary tract is protected by antireflux ureteral implantation.

Forty-five-year follow-up on the renal function after spinal cord injury

“…All of them, however, do show frequent complications, including leakage or stenosis (4,266). The short-term continence rates are over 80% and good protection of the upper urinary tract is achieved (4,13,(264)(265)(266)(267)(268)(269)(270)(271)(272)(273)(274)(275)(276)(277)(278). For cosmetic reasons, the umbilicus is often used for the stoma site, but this may have a higher risk of stenosis (269,271,276).…”

“…Also, in young patients, body image may play a role (273). The patient must be carefully counselled and must comply meticulously with the instructions (4).…”

Treating neuropathic incontinence in children with seromuscular colocystoplasty and an artificial urinary sphincter

“…In addition, it is recognized that the follow-up is short, and that careful monitoring of these patients and subsequent reporting of medium-and longterm results is important. Others have advocated treating these children with continent urinary diversions [15]. Although the long-term results reported in 58 patients were good and no spontaneous perforations were noted, a 17% incidence of stenosis of the uretero-colonic anastomosis appears to be the greatest disadvantage of this approach.…”

Augmentation Cystoplasty: in Pretransplant Recepients

“…Laboratory studies demonstrate a significant non-anion gap acidosis with hyperchloremia and azotemia. Arterial blood gases values are more sensitive than serum bicarbonate or chloride levels for detection and early management of acidosis (61). Acute management includes prompt drainage with treatment of any underlying urinary tract infection and correction of any electrolyte abnormalities.…”