Urinary diversion in children

Abstract

Sir,At a time when paediatricians are referring an increasing number of children with spina bifida for urinary diversion, Scott's (1973) admirable article is most helpful. He points out that diversion by ileal conduit does not necessarily prevent dilatation of the upper tract in those who appear to have a normal upper tract at the time of operation, nor does it necessarily prevent further dilatation in those children who already have some dilatation. In other words, the results of surgery 'for incontinence' are not as good as we would wish-even when the surgery is done by an expert in a good unit.However, before he apologizes too hard for what he has done to a minority of these children, he ought to compare them with a similar group on whom he has not operated. I hope he is doing this now, for while it is interesting to know that a minority of the children acquire dilatation of the upper tracts despite diversion, we would all like to know what would have happened without the operation. Moreover, radiological dilatation is not the only thing that matters in the urinary tract or in the child's life. We need to compare the consequences of both the original state and the diversion, and assess how each affects renal function and, even more importantly, the child's life from the point of view of infections causing illness and incontinence causing misery. Until such a comparison has been reported, diversion procedures by ileal conduit are likely to retain a prominent place in improving the quality of life for many girls with spina bifida.