Ileal conduits in children at the Massachusetts General Hospital from 1955 to 1970.
The 45 ileal conduits performed on children at the Massachusetts General Hospital from 1955 to 1963 are reviewed and compared to the 45 ileal conduits performed from 1964 to 1970. Late complications involving the conduits occurred in 60 per cent of the early group and in 51 per cent of the late group. Of the renal units judged normal pyelographically preoperatively in the early group 77 per cent went on to at least some deterioration, while 62 per cent of the late group judged normal later deteriorated. Combining all renal units, 34 per cent remained unchanged, 26 per cent improved and 41 per cent showed some degree of deterioration after ileal conduit urinary diversion. The late complication and renal deterioration rates seem to increase progressively with time. There was no apparent urinary obstruction in 13 per cent of the renal units that deteriorated. Theoretical and experimental considerations indicate the reflux of infected urine as the etiology of the renal deterioration. Because of the late complications and the unacceptably high rate of renal deterioration we no longer perform ileal conduits in children. Instead every effort is made to reconstruct the urinary tract or if urinary diversion is necessary, a colon conduit with non-refluxing ureterocolonic anastomoses is performed.
D000293:Adolescent; D001746:Bladder Exstrophy / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007223:Infant; D008297:Male; D011704:Pyelonephritis / Q000209:etiology; D012189:Retrospective Studies; D014515:Ureteral Diseases / Q000601:surgery; D014522:Urethral Diseases / Q000601:surgery; D001745:Urinary Bladder Diseases / Q000601:surgery; D014545:Urinary Calculi / Q000209:etiology; D014547:Urinary Diversion / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000209:etiology; D014567:Urography