Urinary diversion in bladder exstrophy and incontinent epispadias: 25 years of experience.
OBJECTIVE
To determine the optimal surgical approach in achieving complete urinary continence with preservation of the upper urinary tract in the exstrophy-epispadias complex we reviewed the records of patients treated at our institution.


METHODS
From 1968 to July 1994, 115 patients with bladder exstrophy/incontinent epispadias were treated of whom followup was available for 104 and 2 died of causes unrelated to urinary diversion. Mean followup is 16.7 years. In 43 of the 102 patients surgery was primarily performed at our institution (urinary diversion in 39, a modified Young-Dees procedure in 1 and sling plasty in 3). In another 59 patients urinary diversion was done secondarily after therapy elsewhere (bladder closure/bladder neck reconstruction in 34 and failed urinary diversion with incontinence in 22). Urinary diversion was performed in 49 patients, a Young-Dees procedure in 7 and genital reconstruction alone in 3.


RESULTS
The present continence rates are 96% for the rectal reservoir, 97% for the Mainz pouch I and 67% for the modified Young-Dees augmentation. Upper tracts have remained stable and no bowel neoplasms have developed.


CONCLUSIONS
Rectal reservoirs represent our urinary diversion of choice. After failed reconstruction/insufficient anal sphincter a Mainz pouch I is constructed and when the upper tract has deteriorated a colon conduit is created.
Stein
R
R
Department of Urology, University of Mainz School of Medicine, Germany.
Fisch
M
M
Stöckle
M
M
Hohenfellner
R
R
D001746:Bladder Exstrophy / Q000601:surgery*; D012809:Colon, Sigmoid / Q000601:surgery; D004842:Epispadias / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D016896:Treatment Outcome; D014519:Ureterostomy; D014547:Urinary Diversion; D014549:Urinary Incontinence / Q000601:surgery*; D016476:Urinary Reservoirs, Continent