Ileal Conduit Urinary Diversion in Children. An Assessment of the Long-Term Results

Abstract

Forty-three children who underwent cutaneous ureteroileostorny are described. Particular attention has been paid t o long-term follow-up, which has produced disappointing results. Deterioration occurred in 61 % of the kidneys studied and although recurring urinary tract infections and stoma1 problems occurred in many patients, no single factor could be implicated a s the cause of deteriorating renal function.Forty-three children who underwent cutaneous ureteroileostomy were studied in order to assess their upper urinary tract function after diversion.

Refluxing or nonrefluxing ureteric anastomosis

“…With the worldwide use of the ileal conduit since the 1950s [ 5], the severe complications seen after ureterosigmoidostomy were reduced. However, it has become obvious from long‐term follow‐up studies of patients with ileal conduits that renal deterioration develops in a significant number of these patients [ 6, 7]. In an attempt to preserve renal function, the colonic conduit with antireflux ureteric implantation was devised [ 8].…”

“…Few clinical studies focus directly on preserving renal function after urinary diversion with given information on renal function status before and after surgery. Many reports have revealed a high incidence (13–41%) of renal deterioration associated with a refluxing ileal conduit, as evaluated using serum creatinine and urography [ 6, 7]. After a long‐term follow‐up (mean 13 years) in patients with colonic conduits, significantly more renal units not showing reflux on the loopogram remained normal on urography than did units with reflux [ 11].…”

The Choice of Suprapubic Continent Catheterisable Urinary Stoma

“…Urinary diversion sometimes seems the only possibility. The long-term renal damage that conduits cause (Orr et al, 1981;Neal, 1985;Pernet and Jonas, 1985;Svare et al, 1985) and the psychological disadvantages of a bag (Jones et al, 1980) still make almost any alternative attractive. In both of these groups a continent diversion emptied through a catheterisable suprapubic stoma should be considered.…”

Long-term Results of Ileal Conduit Diversion in Children-A Brighter Picture?

“…In the series of Dunn et al (1979), 33 of 67 children had stomal problems and 24 required surgical revision. Orr et al (1981) (Elder et al, 1979). The possible relationship of stomal stenosis to the more worrying upper tract deterioration reported by the above authors is not clear.…”