Urinary undiversion in 35 patients with neurogenic bladder and an ileal conduit.
Urinary undiversion was performed in 21 male and 14 female patients with neurogenic bladder and an ileal conduit urinary diversion, 3-17 years after the original operation. Twenty-six patients had surgery for ileal conduit complications but nine had an elective undiversion. In 24 patients, reconstruction was achieved by ureteroureteric anastomoses, in six by ureteroneocystotomy and in five by primary enterocystoplasty. Transureteroureterostomy (TUU) was an essential part of almost all the reconstructive procedures. Secondary operations were necessary in 10 patients, seven of whom had an enterocystoplasty. Improvement or stabilization of the upper urinary tract was eventually achieved in all patients. Twelve male patients void normally with complete urinary control in eleven and incontinence in one. Eight male and all 14 female patients are managed by clean intermittent catheterization (CIC) with complete urinary control in 12, acceptable dampness in eight and incontinence in two. One male patient is managed by an indwelling urethral catheter. All patients showed an improved physical and emotional status and preferred life without a urinary stoma. Urinary undiversion should be considered in all patients with ileal conduit complications and in selected patients with an uncomplicated ileal conduit.
Department of Paediatric Surgery, Adelaide Children's Hospital, South Australia.
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S
Ahmed
H A
HA
Boucaut
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D008722:Methods; D011183:Postoperative Complications; D011859:Radiography; D012086:Reoperation; D001743:Urinary Bladder / Q000601:surgery; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects*