title: Outcomes of incontinent ileovesicostomy in the pediatric patient.
abstract: OBJECTIVE
  Ileovesicostomy is a reconstructive option in complex urological cases but pediatric specific outcomes are lacking. We report our results with pediatric ileovesicostomy.
  
  
  METHODS
  We retrospectively evaluated patients younger than 18 years undergoing incontinent ileovesicostomy at Vanderbilt University. History, urinary tract management and operative course were reviewed in the electronic medical record. Particular attention was given to immediate and long-term postoperative complications.
  
  
  RESULTS
  Nine patients underwent incontinent ileovesicostomy between 2000 and 2013 at a mean age of 10.3 years (range 1.4 to 15.5). Surgical indication was sequelae of neurogenic or nonneurogenic neurogenic bladder (such as infection or worsening hydronephrosis) in 5 patients, reversal of vesicostomy in 3 and closure of cloacal exstrophy in 1. All 9 patients were thought incapable of reliable clean intermittent catheterization due to family unwillingness, poor social support or patient refusal. Median followup was 11.5 months (mean 48.2, range 1.3 to 144.8). Immediate postoperative complications included ileus requiring total parenteral nutrition and a wound infection in 1 patient. Long-term complications included urinary tract infection in 2 patients (febrile in 1 and positive culture for foul smelling urine in 1), stomal issues in 2 and temporary urethral leakage in 1. Constipation affected 3 children in long-term followup (all with neurogenic bowel preoperatively). Postoperative creatinine was stable or improved in all patients.
  
  
  CONCLUSIONS
  Ileovesicostomy is a viable approach in children left with few other options, particularly those who are noncompliant or physically/socially unable to handle catheterization. This operation can help keep such patients out of diapers.
authors: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors: Christina B
authors: CB
authors: Ching
authors: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors: Heidi A
authors: HA
authors: Stephany
authors: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors: Trisha M
authors: TM
authors: Juliano
authors: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors: Douglass B
authors: DB
authors: Clayton
authors: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors: Stacy T
authors: ST
authors: Tanaka
authors: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors: John C
authors: JC
authors: Thomas
authors: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors: Mark C
authors: MC
authors: Adams
authors: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors: John W
authors: JW
authors: Brock
authors: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee. Electronic address: john.pope@vanderbilt.edu.
authors: John C
authors: JC
authors: Pope
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003559:Cystostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D007223:Infant; D057928:Intermittent Urethral Catheterization; D008297:Male; D008591:Meningomyelocele / Q000453:epidemiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics
keywords: BMI; CIC; DLPP; MACE; Malone antegrade continence enema; RBUS; TPN; UTI; body mass index; clean intermittent catheterization; detrusor leak point pressure; neurogenic; pediatrics; renal bladder ultrasound; surgical stomas; total parenteral nutrition; urinary bladder; urinary diversion; urinary tract infection; urinary tract infections