Strategies in urological reconstruction in myelomeningocele.
OBJECTIVE
This paper reviews recent advances in the strategies for urinary tract reconstruction in children with spina bifida. The aims of reconstruction are the preservation of renal function and achievement of urinary continence. Considerable controversy exists on the subjects of bladder augmentation, procedures to increase outlet resistance, and continent stomas. The authors put the most recently published information in perspective in the light of their own personal experience.


RESULTS
Thirty-seven papers covering the above-mentioned subjects published in the past 5 years (25 of them published since 2000) have been selected. Seven relevant older references are included. There is persistent interest in developing methods to enlarge the urinary bladder that avoid bringing the urine in contact with the intestinal mucosa. The artificial urinary sphincter and fascial slings are the most frequently reported methods to increase outlet resistance. The Mitrofanoff principle continues to be regarded as an effective method to construct a continent catheterizable channel, either with the appendix or reconfigured intestinal segments. The achievement of fecal continence has to be pursued in parallel with urinary continence. Incontinent diversions continue to be best for a small group of patients. The role of continent urinary diversion requires reassessment.


CONCLUSIONS
Progress in this area continues to be made. Periodic, critical and objective reviews on the subject should help the practitioner to arrive at sound decisions.
González
Ricardo
R
Division of Pediatric Urology, University of Miami, Florida 33101, USA. rgonzal4@med.miami.edu
Schimke
Christa M
CM
D002648:Child; D006801:Humans; D008591:Meningomyelocele / Q000150:complications*; D019651:Plastic Surgery Procedures; D001743:Urinary Bladder / Q000002:abnormalities / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods; D014551:Urinary Tract / Q000002:abnormalities* / Q000601:surgery*; D013520:Urologic Surgical Procedures