15 years of continent urinary diversion and enterocystoplasty in children and adolescents: the Würzburg experience.
OBJECTIVE
To assess the long-term results of continent urinary diversion (CUD) and enterocystoplasty (ECP) in children with irreversible lower urinary tract dysfunction (LUTD).


METHODS
The study included 44 children with irreversible LUTD who had a CUD or ECP between 1992 and 2007. Patients were followed for the functional outcome of surgery with a focus on complications related to the reservoir, bowel, uretero-intestinal anastomosis and upper urinary tract. Data were collected prospectively and outcomes were evaluated using a standardized protocol.


RESULTS
The median (range) follow-up was 7.3 (3.5-17) years. Complete continence was achieved in 94% overall, i.e. in 95% of patients with continent cutaneous diversion, 83% with ECP and all children with continent anal diversion. Upper urinary tract and renal function remained stable in 89% and 95%, respectively. Surgical intervention was required for adhesive small bowel ileus in 6%, stoma-related complications in 39%, ureteric stenosis in 8%, and stone formation in 19%. Of these complications, 54% required only minor interventions; 41% of patients needed prophylactic alkaline substitution. Bowel habits remained unchanged or improved in 68%.


CONCLUSIONS
Our results show that CUD and ECP in children are effective procedures with acceptable long-term complication rates. However, conclusions from our data might be limited, as this was a small study including highly selected patients treated at one tertiary academic centre. Being an audit of practice in our institution and given the variety of concepts, these results might differ from those centres using other approaches in the surgical treatment of LUTD. Importantly, this type of surgery should be restricted to carefully selected patients in whom all attempts of restoring the LUT failed.
Rubenwolf
Peter C
PC
Departments of Urology and Paediatric Urology, Bavarian Julius-Maximilians-University Medical School, Würzburg, Germany. Peter.Rubenwolf@barmherzigeregensburg.de
Beissert
Antje
A
Gerharz
Elmar W
EW
Riedmiller
Hubertus
H
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D014549:Urinary Incontinence / Q000601:surgery; D016476:Urinary Reservoirs, Continent