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

Abstract

After failure of conservative treatment of neurogenic bladders (deterioration of the upper urinary tract/incontinence) continent cutaneous diversion has to be considered in those patients with irreparable urethral sphincter defects or those who are unable to perform trans-urethral self-catheterization. In this second part of the study we investigated the long-term safety of using the Mainz pouch I with regard to protecting the upper urinary tracts and to provide urine continence. Between 1985 and 2002, operations to form an ileocaecal pouch with umbilical stoma (Mainz pouch I) were performed on 70 children and adolescents of median age 15.3 years (range 5.7-20 years). During the follow-up period five patients died 2.4-14 years postoperatively of causes not related to urinary diversion. A follow-up period of 8.7 years (0.9-18) was achieved in 65 patients with 118 renal units (RUs). As compared to preoperatively, the upper urinary tracts had remained stable or improved in 113/118 RUs (95.8%) at the latest follow-up. Complete continence was achieved in 97% of patients with a continent cutaneous diversion. Surgical revisions were required for: incontinence of the outlet mechanism in 9%, stoma prolapse in 2%, stoma stenosis in 23%, pouch calculi in 15%, symptomatic reflux in 1%, ureter stenosis in 16% of the RUs with submucosal tunnel and in 3% of the RUs with an extramural tunnel. We conclude that, in patients with irreparable sphincter defect and those who are unable to perform urethral self-catheterization, continent cutaneous urinary diversion with the Mainz pouch I provides a high continence rate with preservation of the upper urinary tracts in the long run. In patients with dilated ureters, the extramural tunnel technique results in a lower complication rate.

Report of an NIH task force on research priorities in chronic kidney disease in children

“…The database will contain 100,000 children and their families, and a multi-site sample of women will be enrolled in early pregnancy. There will be potential for sub-studies and the use of state-of-the-art technology for tracking, measurement, and data management [126,127]. The study will run from 2007 to 2030.…”

Bladder augmentation and urinary diversion in patients with neurogenic bladder: Surgical considerations

“…The artificial sphincter provides continence rates of up to 80e90% in carefully selected patients, but the revision rate may be as high as 100% [56e58]. Careful selection of patients based on cystometry and urethral pressure profilometry results in a higher continence rate after bladder augmentation and bladder substitution using the ileocaecal segment [60].…”

Bladder augmentation and urinary diversion in patients with neurogenic bladder: Non-surgical considerations

“…Almost 50% of patients with a neurogenic bladder, in whom the ileocaecal segment (Mainz pouch procedure) was used for urinary tract reconstruction, receive prophylactic alkali substitution, e.g. Na þ /K þ -citrate, on a regular basis [23,24]. In patients, who do not have access to regular follow up, prophylactic alkali substitution using sodium bicarbonate is recommended.…”