title: Ileal urinary reservoir in pediatric population: objective assessment of long-term sequelae with time-to-event analysis.
abstract: OBJECTIVE
  To evaluate the long-term outcomes of an ileal urinary reservoir in children.
  
  
  METHODS
  This was a longitudinal study of pediatric patients who had undergone total ileal substitution of the bladder. Continence status was assessed, and all patients were evaluated for kidney function and biochemical profile. Standardized growth charts were used to assess linear growth. To assess bone mineral density, dual-emission x-ray absorptiometry scanning was performed. Clavien's scale was used to report and grade the long-term complications and their timing. We used a simple quality of life questionnaire to assess the effect of the procedure on the quality of life of the growing child.
  
  
  RESULTS
  A total of 17 patients were included; 3 with orthotopic and 14 with continent cutaneous reservoirs. After a mean follow-up of 87.3 months, all patients were voiding with clean intermittent catheterization, with a 94% final continence rate. Two patients (11.7%) had an estimated glomerular filtration rate of ≤ 45 mL/min/1.73 m(2) at the last follow-up examination. However, no clinically manifest metabolic acidosis was detected. No anemia or neurologic deficit was detected, with a low-normal serum level of vitamin B(12) in 2 patients (11.7%) and a low level in 1 patient (5.7%). One patient (5.7%) had chronic diarrhea. Low bone mineral density was found in 4 patients (22.8%), with 3 patients (17.1%) not exceeding the fifth percentile of height for age. High-grade complications (grade 3a-5) represented 64.5% of the complications, and the need for reintervention occurred late in the follow-up period. A high level of quality of life satisfaction was reported (88.5%).
  
  
  CONCLUSIONS
  Ileal neobladder construction allows child to pass into adolescence dry with more confidence and self-esteem, with no external urine collection set. However, long-term follow-up is mandatory to maintain the positive outcome.
authors.affiliation: Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. elshalam@hotmail.com
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elshal
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelhalim
authors.forename: Ashraf T
authors.initials: AT
authors.lastname: Hafez
authors.forename: Hassan
authors.initials: H
authors.lastname: Abol-Enein
mesh_terms: D000293:Adolescent; D001437:Bacteriuria / Q000209:etiology; D001827:Body Height; D015519:Bone Density; D002648:Child; D002675:Child, Preschool; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007082:Ileum / Q000601:surgery; D057928:Intermittent Urethral Catheterization; D008297:Male; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000009:adverse effects / Q000523:psychology; D014549:Urinary Incontinence / Q000209:etiology / Q000523:psychology; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D014805:Vitamin B 12