Continent urinary diversion

The children's hospital experience

Martin Kaefer, Matthew S. Tobin, W. Hardy Hendren, Stuart B. Bauer, Craig A. Peters, Anthony Atala, Arnold H. Colodny, James Mandell, Alan B. Retik

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

Purpose: Continent urinary diversion has become increasingly important for treating childhood urinary tract pathology that cannot be managed by direct reconstructive techniques. We review our 9-year experience with continent diversion. Materials and Methods: Since 1986 continent diversions were created in 74 patients 3 to 38 years old (mean age 13.7). The underlying pathological condition was the exstrophy/epispadias complex in 34 patients, neurological disorders in 23, malignancy in 13 and other congenital anomalies in 4. Followup averaged 5.2 years after the last procedure. Nonbladder reservoirs in 39 patients (53%) were fashioned from ileocolic (17), colic (7), gastrocolic (6), sigmoid (3), gastrosigmoid (2), ileosigmoid (2), ileal (1) and gastroileac (1) segments. When possible, the native bladder was incorporated into the reconstructive strategy. A total of 26 patients underwent bladder augmentation with intestine or stomach, including ileal (11), gastric (8), sigmoid (3), gastroileac (2) and ileocolic (2) segments. Nine other patients did not require bladder augmentation. Continence mechanisms were a flap valve (Mitrofanoff principle) in 50 patients, nipple valve in 15 and ileal plication (Indiana pouch) in 9. When the Mitrofanoff principle was used with a native bladder reservoir in 30 cases, outlet resistance was altered by bladder neck division (15), fascial sling placement (6) or Young-Dees-Leadbetter bladder neck reconstruction (2). In the remaining 7 patients the bladder neck remained intact. Results: Excellent continence was obtained. The Mitrofanoff principle initially provided continence in 41 patients (82%). Six of the 9 incontinent patients were dry after a single revision. A total of 13 patients (87%) with nipple valves and 7 (78%) with Indiana pouches were dry, and the remaining 5 were cured after a single revision. Ultimately continence was achieved in 71 of the 74 patients (96%) after a maximum of 2 operations. Of the 48 complications in 29 patients the most common were difficulty in catheterizing (11), stones (11), infection (8) and upper tract deterioration (4). Conclusions: Many options exist for reconstructing complex anomalies. Choices must be individualized based on patient anatomy. The dry state may be achieved in most cases without resorting to a bag on the abdomen.

Original languageEnglish (US)
Pages (from-to)1394-1399
Number of pages6
JournalJournal of Urology
Volume157
Issue number4
DOIs
StatePublished - Apr 1997
Externally publishedYes

Fingerprint

Urinary Diversion
Urinary Bladder
Nipples
Sigmoid Colon
Stomach
Epispadias
Colic
Nervous System Diseases
Urinary Tract
Abdomen
Intestines
Anatomy

Keywords

  • abnormalities
  • bladder
  • ileum
  • urinary reservoirs, continent

ASJC Scopus subject areas

  • Urology

Cite this

Kaefer, M., Tobin, M. S., Hendren, W. H., Bauer, S. B., Peters, C. A., Atala, A., ... Retik, A. B. (1997). Continent urinary diversion: The children's hospital experience. Journal of Urology, 157(4), 1394-1399. https://doi.org/10.1016/S0022-5347(01)64998-X

Continent urinary diversion : The children's hospital experience. / Kaefer, Martin; Tobin, Matthew S.; Hendren, W. Hardy; Bauer, Stuart B.; Peters, Craig A.; Atala, Anthony; Colodny, Arnold H.; Mandell, James; Retik, Alan B.

In: Journal of Urology, Vol. 157, No. 4, 04.1997, p. 1394-1399.

Research output: Contribution to journalArticle

Kaefer, M, Tobin, MS, Hendren, WH, Bauer, SB, Peters, CA, Atala, A, Colodny, AH, Mandell, J & Retik, AB 1997, 'Continent urinary diversion: The children's hospital experience', Journal of Urology, vol. 157, no. 4, pp. 1394-1399. https://doi.org/10.1016/S0022-5347(01)64998-X
Kaefer M, Tobin MS, Hendren WH, Bauer SB, Peters CA, Atala A et al. Continent urinary diversion: The children's hospital experience. Journal of Urology. 1997 Apr;157(4):1394-1399. https://doi.org/10.1016/S0022-5347(01)64998-X
Kaefer, Martin ; Tobin, Matthew S. ; Hendren, W. Hardy ; Bauer, Stuart B. ; Peters, Craig A. ; Atala, Anthony ; Colodny, Arnold H. ; Mandell, James ; Retik, Alan B. / Continent urinary diversion : The children's hospital experience. In: Journal of Urology. 1997 ; Vol. 157, No. 4. pp. 1394-1399.
@article{2ad3038d46484a1c8845a11d99948582,
title = "Continent urinary diversion: The children's hospital experience",
abstract = "Purpose: Continent urinary diversion has become increasingly important for treating childhood urinary tract pathology that cannot be managed by direct reconstructive techniques. We review our 9-year experience with continent diversion. Materials and Methods: Since 1986 continent diversions were created in 74 patients 3 to 38 years old (mean age 13.7). The underlying pathological condition was the exstrophy/epispadias complex in 34 patients, neurological disorders in 23, malignancy in 13 and other congenital anomalies in 4. Followup averaged 5.2 years after the last procedure. Nonbladder reservoirs in 39 patients (53{\%}) were fashioned from ileocolic (17), colic (7), gastrocolic (6), sigmoid (3), gastrosigmoid (2), ileosigmoid (2), ileal (1) and gastroileac (1) segments. When possible, the native bladder was incorporated into the reconstructive strategy. A total of 26 patients underwent bladder augmentation with intestine or stomach, including ileal (11), gastric (8), sigmoid (3), gastroileac (2) and ileocolic (2) segments. Nine other patients did not require bladder augmentation. Continence mechanisms were a flap valve (Mitrofanoff principle) in 50 patients, nipple valve in 15 and ileal plication (Indiana pouch) in 9. When the Mitrofanoff principle was used with a native bladder reservoir in 30 cases, outlet resistance was altered by bladder neck division (15), fascial sling placement (6) or Young-Dees-Leadbetter bladder neck reconstruction (2). In the remaining 7 patients the bladder neck remained intact. Results: Excellent continence was obtained. The Mitrofanoff principle initially provided continence in 41 patients (82{\%}). Six of the 9 incontinent patients were dry after a single revision. A total of 13 patients (87{\%}) with nipple valves and 7 (78{\%}) with Indiana pouches were dry, and the remaining 5 were cured after a single revision. Ultimately continence was achieved in 71 of the 74 patients (96{\%}) after a maximum of 2 operations. Of the 48 complications in 29 patients the most common were difficulty in catheterizing (11), stones (11), infection (8) and upper tract deterioration (4). Conclusions: Many options exist for reconstructing complex anomalies. Choices must be individualized based on patient anatomy. The dry state may be achieved in most cases without resorting to a bag on the abdomen.",
keywords = "abnormalities, bladder, ileum, urinary reservoirs, continent",
author = "Martin Kaefer and Tobin, {Matthew S.} and Hendren, {W. Hardy} and Bauer, {Stuart B.} and Peters, {Craig A.} and Anthony Atala and Colodny, {Arnold H.} and James Mandell and Retik, {Alan B.}",
year = "1997",
month = "4",
doi = "10.1016/S0022-5347(01)64998-X",
language = "English (US)",
volume = "157",
pages = "1394--1399",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Continent urinary diversion

T2 - The children's hospital experience

AU - Kaefer, Martin

AU - Tobin, Matthew S.

AU - Hendren, W. Hardy

AU - Bauer, Stuart B.

AU - Peters, Craig A.

AU - Atala, Anthony

AU - Colodny, Arnold H.

AU - Mandell, James

AU - Retik, Alan B.

PY - 1997/4

Y1 - 1997/4

N2 - Purpose: Continent urinary diversion has become increasingly important for treating childhood urinary tract pathology that cannot be managed by direct reconstructive techniques. We review our 9-year experience with continent diversion. Materials and Methods: Since 1986 continent diversions were created in 74 patients 3 to 38 years old (mean age 13.7). The underlying pathological condition was the exstrophy/epispadias complex in 34 patients, neurological disorders in 23, malignancy in 13 and other congenital anomalies in 4. Followup averaged 5.2 years after the last procedure. Nonbladder reservoirs in 39 patients (53%) were fashioned from ileocolic (17), colic (7), gastrocolic (6), sigmoid (3), gastrosigmoid (2), ileosigmoid (2), ileal (1) and gastroileac (1) segments. When possible, the native bladder was incorporated into the reconstructive strategy. A total of 26 patients underwent bladder augmentation with intestine or stomach, including ileal (11), gastric (8), sigmoid (3), gastroileac (2) and ileocolic (2) segments. Nine other patients did not require bladder augmentation. Continence mechanisms were a flap valve (Mitrofanoff principle) in 50 patients, nipple valve in 15 and ileal plication (Indiana pouch) in 9. When the Mitrofanoff principle was used with a native bladder reservoir in 30 cases, outlet resistance was altered by bladder neck division (15), fascial sling placement (6) or Young-Dees-Leadbetter bladder neck reconstruction (2). In the remaining 7 patients the bladder neck remained intact. Results: Excellent continence was obtained. The Mitrofanoff principle initially provided continence in 41 patients (82%). Six of the 9 incontinent patients were dry after a single revision. A total of 13 patients (87%) with nipple valves and 7 (78%) with Indiana pouches were dry, and the remaining 5 were cured after a single revision. Ultimately continence was achieved in 71 of the 74 patients (96%) after a maximum of 2 operations. Of the 48 complications in 29 patients the most common were difficulty in catheterizing (11), stones (11), infection (8) and upper tract deterioration (4). Conclusions: Many options exist for reconstructing complex anomalies. Choices must be individualized based on patient anatomy. The dry state may be achieved in most cases without resorting to a bag on the abdomen.

AB - Purpose: Continent urinary diversion has become increasingly important for treating childhood urinary tract pathology that cannot be managed by direct reconstructive techniques. We review our 9-year experience with continent diversion. Materials and Methods: Since 1986 continent diversions were created in 74 patients 3 to 38 years old (mean age 13.7). The underlying pathological condition was the exstrophy/epispadias complex in 34 patients, neurological disorders in 23, malignancy in 13 and other congenital anomalies in 4. Followup averaged 5.2 years after the last procedure. Nonbladder reservoirs in 39 patients (53%) were fashioned from ileocolic (17), colic (7), gastrocolic (6), sigmoid (3), gastrosigmoid (2), ileosigmoid (2), ileal (1) and gastroileac (1) segments. When possible, the native bladder was incorporated into the reconstructive strategy. A total of 26 patients underwent bladder augmentation with intestine or stomach, including ileal (11), gastric (8), sigmoid (3), gastroileac (2) and ileocolic (2) segments. Nine other patients did not require bladder augmentation. Continence mechanisms were a flap valve (Mitrofanoff principle) in 50 patients, nipple valve in 15 and ileal plication (Indiana pouch) in 9. When the Mitrofanoff principle was used with a native bladder reservoir in 30 cases, outlet resistance was altered by bladder neck division (15), fascial sling placement (6) or Young-Dees-Leadbetter bladder neck reconstruction (2). In the remaining 7 patients the bladder neck remained intact. Results: Excellent continence was obtained. The Mitrofanoff principle initially provided continence in 41 patients (82%). Six of the 9 incontinent patients were dry after a single revision. A total of 13 patients (87%) with nipple valves and 7 (78%) with Indiana pouches were dry, and the remaining 5 were cured after a single revision. Ultimately continence was achieved in 71 of the 74 patients (96%) after a maximum of 2 operations. Of the 48 complications in 29 patients the most common were difficulty in catheterizing (11), stones (11), infection (8) and upper tract deterioration (4). Conclusions: Many options exist for reconstructing complex anomalies. Choices must be individualized based on patient anatomy. The dry state may be achieved in most cases without resorting to a bag on the abdomen.

KW - abnormalities

KW - bladder

KW - ileum

KW - urinary reservoirs, continent

UR - http://www.scopus.com/inward/record.url?scp=0030897836&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030897836&partnerID=8YFLogxK

U2 - 10.1016/S0022-5347(01)64998-X

DO - 10.1016/S0022-5347(01)64998-X

M3 - Article

VL - 157

SP - 1394

EP - 1399

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 4

ER -