Mucus Production Consequences in Cystoplasties and Continent Urinary Diversions in Children –⁠ Long Term Experiences

Overview

Introduction:
Following transposition into the urinary tract, intestinal segments continue to produce mucus and problems related to excessive production do not to diminish with time. The aim of the study is to assess complications connected with excessive mucous production in unsatisfactory cooperative patients with various types of cystoplasties and urinary bladder replacements.

Patients and methods:
45 children aged 2–18 years underwent surgery between 1991 and 2005 in our department. Ileocecal urinary reservoir (13), ileocystoplasty (25), sigmoideocystoplasty (2), gastroileocystoplasty (1) and gastrocystoplasty (4) with continent appendicovesicostomy (25) and ileovesicostomy (5) were created. Surgical results with a particular attention to the complications of mucous retention, calculus formation and ruptures of the neobladder were assessed on the basis of data from questionnaires mailed to relevant patients and from their medical documents.

Results:
Full continence was achieved in 97% patients with catheterizable stoma and 81% children with patent urethra. Excessive mucous production occured in 13 (29%) children, reservoir calculi and neobladder rupture in 2 (4%) patients. In this time, 26 (58%) children practise regular irrigation.

Conclusion:
Although continent urinary diversion using intestinal or gastric segments may improve the quality of life in severely affected patients, it remains an imperfect solution requiring significant cooperation from patients. Many problems may be prevented by the use of suitable surgical techniques, the mucus production and lithiasis by regular catheterization and lavages of the urinary bladder only. The recommended procedures are, however, sometimes neglected even by properly instructed patients or their parents.

Key words:
continent urinary diversion –⁠ cystoplasty –⁠ intermitent catheterization –⁠ mucus production –⁠ complications