title: Urinary diversion in early childhood: indications and outcomes in the exstrophy patients.
abstract: OBJECTIVE
  To evaluate indications and applicability of continent and incontinent urinary diversion (CUD and IUD, respectively) in early childhood in patients with classic bladder exstrophy (CBE).
  
  
  METHODS
  Using an institutionally approved exstrophy database, patients with CBE born after 1980 who underwent CUD or IUD by 2 surgeons within the first 5 years of life were identified. All aspects of their care and clinical outcomes were studied.
  
  
  RESULTS
  In the CUD group (n = 14), only 21% had successful primary closure. Indications were desire to be dry (7), persistent hydronephrosis (4), urinary tract infections (UTIs) (1), repeat CUD (1), and inaccessible proper follow-up (1). Three patients had neobladder creation, 10 had bladder augmentation with continent stomas, and 2 underwent ureterosigmoidostomy. Currently, all patients are dry with clean intermittent catheterization (CIC). In the IUD group (n = 5), only 1 had successful primary closure. In addition to small, noncontractile bladders, the indications for IUD were severe hydronephrosis (2), recurrent UTIs (2), and noncompliance with catheterization (1). Four patients were re-diverted to CUD after a mean of 9.4 years and 1 has colon conduit. All are socially dry via catheterization. There was no case of renal function loss or malignant transformation.
  
  
  CONCLUSIONS
  The need for early diversion in CBE is primarily driven by upper tract changes after secondary closure and social factors. Urinary diversion can be safe in younger children with a favorable continence outcome.
authors.affiliation: Division of Pediatric Urology, Brady Urological Institute Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Nima
authors.initials: N
authors.lastname: Baradaran
authors.forename: Andrew
authors.initials: A
authors.lastname: Stec
authors.forename: Ming-Hsien
authors.initials: MH
authors.lastname: Wang
authors.forename: Raimondo Maximilian
authors.initials: RM
authors.lastname: Cervellione
authors.forename: Jordan
authors.initials: J
authors.lastname: Luskin
authors.forename: John Philip
authors.initials: JP
authors.lastname: Gearhart
mesh_terms: D000367:Age Factors; D001746:Bladder Exstrophy / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000379:methods