title: Bricker Conduit for Pediatric Urinary Diversion--Should we Still Offer It?
abstract: OBJECTIVE
  We sought to evaluate long-term outcomes of the Bricker conduit urinary diversion in children.
  
  
  METHODS
  We retrospectively reviewed the database of a single tertiary center for children who had undergone ileal conduit between 1981 and 2011. Patients followed for less than 1 year were excluded. Patient files were reviewed for demographics, diversion indication, preoperative imaging, surgical details, hospital readmissions and followup data. Renal function at baseline and last followup was assessed by estimated glomerular filtration rate, calculated using the modified Schwartz or MDRD (Modified Diet in Renal Disease) formula. Growth charts elucidated patient growth patterns, while an internally designed quality of life questionnaire demonstrated patient and family satisfaction with the procedure.
  
  
  RESULTS
  We evaluated 29 children who underwent Bricker conduit at a median age of 10 years (range 2 to 18) and were followed for a median of 91 months (16 to 389). Neuropathic bladder was the underlying diagnosis in 72.4% of cases. Hydronephrosis improved or remained stable in 39 of 55 studied renal units (70.9%). Although no statistically significant difference was observed between mean ± SD baseline (64.5 ± 46 ml/minute/1.73 m(2)) and last followup estimated glomerular filtration rate (54.1 ± 44.9 ml/minute/1.73 m(2)), chronic kidney disease stage had worsened in 13 patients (44.8%), end-stage kidney disease had developed in 11 patients and 9 patients had died. Six patients underwent undiversion after stabilization of renal function. Linear growth was negatively affected in 12 patients (41.4%), and 85% reported poor quality of life. A total of 19 hospital readmissions were required in 14 patients to treat diversion related complications.
  
  
  CONCLUSIONS
  The Bricker conduit does not seem to halt renal deterioration in children. Negative impact on growth and quality of life, and the anticipated rate of complications are significant limitations of the procedure in the pediatric population.
authors.affiliation: Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. Electronic address: a_halim_2010@yahoo.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelhalim
authors.affiliation: Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elshal
authors.affiliation: Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Amr A
authors.initials: AA
authors.lastname: Elsawy
authors.affiliation: Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Tamer E
authors.initials: TE
authors.lastname: Helmy
authors.affiliation: Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Hesham A
authors.initials: HA
authors.lastname: Orban
authors.affiliation: Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Dawaba
authors.affiliation: Department of Urology, Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
authors.forename: Ashraf T
authors.initials: AT
authors.lastname: Hafez
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004534:Egypt / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D015994:Incidence; D007674:Kidney Diseases / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014547:Urinary Diversion / Q000379:methods* / Q000523:psychology
keywords: child; glomerular filtration rate; quality of life; urinary diversion