Continent urinary reconstruction in ischiopagus tripus conjoined twins.
The principle of the continent urinary reservoir involves use of a variety of intestinal segments providing continence, a mechanism of antireflux and a catheterizable stoma in either an abdominal or pelvic location. This concept was used to create a continent urinary reservoir in a 3-year-old former ischiopagus tripus conjoined twin. The solitary renal unit had been drained into a hydrocolpos with an antirefluxing ureteral reimplantation at separation. The patient remained incontinent through the urogenital sinus. At subsequent reconstruction the posterior aspect of the hydrocolpos was tubularized as a vagina, while the remainder of the hydrocolpos was augmented with ileum to create a urinary reservoir. The conduit was constructed with imbricated ileum, in which myectomy had been performed to allow for easier imbrication and tubularization for a narrow neourethra. A second set of conjoined twins have been separated similarly. Of these twins 1 will undergo creation of a continent urinary reservoir in an identical fashion. This represents the first report of the use of hydrocolpos in the creation of a urinary reservoir.
Holcomb
G W
GW
Department of Surgery, Children's Hospital of Philadelphia, Pennsylvania 19104.
Keating
M A
MA
Hollowell
J G
JG
Murphy
J P
JP
Duckett
J W
JW
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D014428:Twins, Conjoined / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014551:Urinary Tract / Q000002:abnormalities* / Q000601:surgery; D014621:Vagina / Q000601:surgery*