Long-term results of ureterosigmoidostomy in children with bladder exstrophy.
OBJECTIVE
We evaluated long-term results of patients with bladder exstrophy who underwent ureterosigmoidostomy.


METHODS
Of 4 women and 23 men monitored at our institution 16 (59%) underwent primary diversion by ureterosigmoidostomy, while 11 (41%) underwent primary bladder closure or an ileal conduit procedure before conversion to ureterosigmoidostomy. Average followup after ureterosigmoidostomy was 17 years.


RESULTS
Significant upper urinary tract changes developed in 18% of the patients. Metabolic acidosis was well compensated in most patients but 2 had problems with urinary retention leading to hyperammonemia and acidosis. Of the 19 patients monitored with biennial colonoscopy benign polyps were removed in 4. Daytime continence was achieved in 92% of cases and nighttime continence in 58%.


CONCLUSIONS
Our experience with ureterosigmoidostomy in children with bladder exstrophy has been favorable through long-term followup. With proper imaging, metabolic surveillance, biennial colonoscopy and nonsteroidal anti-inflammatory drugs we offer ureterosigmoidostomy as a viable alternative for patients with small bladders.
Division of Urology, Children's Hospital of Philadelphia, Pennsylvania, USA.
H P
HP
Koo
L
L
Avolio
J W
JW
Duckett
D001746:Bladder Exstrophy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D012809:Colon, Sigmoid / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D013997:Time Factors; D014519:Ureterostomy / Q000009:adverse effects