Continent Substitution of Urethra in Children - 7 Years’Experience

Overview

Since 1991 continent substitutions of the urethra as part of continent urinary diversions wereperformed in 21 children, twelve girls and nine boys aged between 4 and 16 years. They hadbeen treated for neurogenic dysfunction of the lower urinary tract, bladder exstrophy andcomplications after anal atresia repair. A catheterisable (neo)vesicostomy was performed usingthe appendix (16) and ileum (5) in ileocecal detubularised reservoir (13), ileal augmentationcystoplasty (5), ileocecal enterocystoplasty (1) and neurogenic dysfunctional bladder as conti-nent vesicostomy (2).All patients are kept under continual follow-up with regard to vesicostomy continence, urinarybladder function, upper urinary tract status, renal and metabolic functions. So far there wereno significant difficulties. We evaluated mainly long-term postoperative cooperation of patientsand their parents and the impact of a continent stoma on the psychosocial development ofchildren. Late mechanical complications occurred in 7 patients and required surgical repair in5 cases. Bladder lithiasis occurred in one patient and insufficient active cooperation wasobserved in one older boy.The clinical outcome of continent urinary diversions has been very good in general with a highdegree of patient satisfaction. Our experience was very good even in small children.

Key words:
urethra - continent substitution - children - surgery.