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

Abstract

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.

A Study of Renal Transplant for Patients with Neurogenic Bladder

“…These patients had intra-vesical pressure > 40 cm H 2 O or had confirmed upper urinary tract dysfunction and/or incontinence despite regular CICs. Therefore, we considered that it was necessary to improve their bladder compliance for preventing post-transplantation upper UTIs and preserving renal graft function [10,11]. Moreover, patients with VUR of Grade 3 or higher, will be at high risk of UTIs while being treated with post-operative immunosuppressant therapy.…”

Current Trends in Urinary Diversion in Men

“…Neural tube defect or spinal cord injured patients) the main indications for such surgery is represented by intractable incontinence, deteriorating renal function and high bladder pressures. The choices would include either bladder reconstruction, replacement or continent diversion [3]. Equally in subjects with severe idiopathic detrusor overactivity, if conservative measures fail the surgical therapy which may involve transposition of intestinal segments into the urinary tract (e.g.…”

Botulinumtoxin in der Urologie

“…Harnableitungen wie dem MAINZ-I oder II Pouch sowie die inkontinenten Harnableitungen mittels Ileum-oder Colon-Conduit zur Verfügung (Bissada et al, 2007;Daher et al, 2007;Hayashi et al, 2006;Kumar and Abrams, 2005;MacNeily et al, 2003;Marte et al, 2002;Mingin and Baskin, 2003;Rawashdeh et al, 2004;Stein et al, 2005a;Stein et al, 2005b;Stein et al, 2005c). Eine umfassende retrospektive Analyse eigener Daten über verschiedene…”

“…Operationsmaßnahmen bei diesen Patienten in den vergangenen 35 Jahren publizierten Stein et al (Stein et al, 2005a;Stein et al, 2005b;Stein et al, 2005c 59.60 ± 7.04 34.93 # ± 5.48 46.67 n.s. ± 8.73 61.75 n.s.…”