Continent urinary diversion: 10-year experience of Shriners Hospitals for Children in Chicago.
OBJECTIVE
To review long-term functional results, complications, and patient satisfaction in patients with a continent catheterizable urinary diversion.


METHODS
A retrospective chart review and telephone satisfaction interviews were conducted. Bladder dysfunction was attributed to neurogenic bladder (n = 48: 23 spinal cord injury, 18 myelomeningocele, 4 sacral agenesis, 3 cerebral palsy), bladder exstrophy (n = 2), posterior urethral valves (n = 1), and other (n = 3). Patients underwent continent urinary diversion with either the Mitrofanoff principle (appendicovesicostomy, n = 47) or a Monti tube (ileovesicostomy, n = 8). Outcomes were assessed by chart review. Patient satisfaction was assessed by telephone interview and scored from 1 to 10 on a Likert-type scale.


RESULTS
Between 1992 and 2003, 54 continent urinary diversions were performed on 17 boys and 37 girls. Mean age was 15.3 years (range, 7-21 years). An umbilical stoma was created in all patients. Seventy-three percent (40/54) and 47% (26/54) underwent concomitant bladder augmentation and urethral sling procedure, respectively. Mean follow-up was 2.5 years (range, 3 months to 10 years). Ninety-five percent (51/54) of patients were continent, and 5% (3/54) were incontinent from the umbilical stoma after one operation. All were compliant with intermittent catheterization. Complications included bladder calculi (15%; 8/54), stomal stenosis (9%; 5/54), stomal bleeding (5%; 3/54), small bowel obstruction (2%; 1/54), and superficial wound dehiscence (2%; 1/54). Seventy-three percent (40/54) of patients were available for telephone interview. Of these, 90% (36/40) reported satisfaction, and 10% (4/40) reported dissatisfaction; 93% (37/40) reported that they would recommend the procedure to others, whereas 7% (3/40) would not.


CONCLUSIONS
In our series, continent urinary diversion with the Mitrofanoff principle or Monti tube is associated with high continence, compliance, and satisfaction rates and a low complication rate. An umbilical stoma was achievable in all patients. Our 10-year experience is consistent with other reported series and underscores the successful long-term outcome and durability of continent urinary diversions.
Chulamorkodt
Natakom N
NN
Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA. nchula1@vic.edu
Estrada
Carlos R
CR
Chaviano
Antonio H
AH
D000293:Adolescent; D000328:Adult; D001065:Appendix / Q000601:surgery; D001746:Bladder Exstrophy / Q000601:surgery; D002641:Chicago; D002648:Child; D003559:Cystostomy / Q000009:adverse effects / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000601:surgery; D001750:Urinary Bladder, Neurogenic / Q000601:surgery