title: [Bladder augmentation and urinary diversion in children and adolescents].
abstract: BACKGROUND
  In children and adolescents, the indication for continent urinary diversion or bladder augmentation is rare. Today, for most patients with a neurogenic bladder, conservative treatment (clean intermittent catheterization [CIC] and pharmacotherapy) is the method of choice, while for patients with bladder exstrophy-epispadias complex (BEEC), primary reconstruction is recommended. Only after failure of conservative treatment or primary reconstruction should bladder augmentation or urinary diversion be considered. Other rare indications include patients with malignant tumor involving the lower urinary tract (e. g., rhabdomyosarcoma).
  
  
  CONCLUSIONS
  In patients with a hyperreflexive, small capacity, and/or low compliance bladder with a normal upper urinary tract, bladder augmentation (bowel segments/ureter) is an option. For those unable to perform CIC via the urethra, a continent cutaneous stoma should be offered. In patients with irreparable sphincter defects and normal renal function, a continent cutaneous diversion is an option and in those with a competent anal sphincter the rectosigmoid pouch can be offered.
  
  
  CONCLUSIONS
  In this review, surgical options with their advantages and disadvantages are discussed.
authors.affiliation: Zentrum für Kinder- und Jugendurologie, Universitätsmedizin Mannheim, Medizinische Fakultäten Mannheim der Universität Heidelberg; Universitätsklinikum, Theodor-Kutzner-Ufer 1-3, 68167, Mannheim, Deutschland. raimund.stein@umm.de.
authors.forename: R
authors.initials: R
authors.lastname: Stein
authors.affiliation: Klinik für Kinderchirurgie, Universitätsmedizin Mannheim, Medizinische Fakultäten Mannheim der Universität Heidelberg; Universitätsklinikum, Theodor-Kutzner-Ufer 1-3, 68167, Mannheim, Deutschland.
authors.forename: L
authors.initials: L
authors.lastname: Wessel
authors.affiliation: Urologische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultäten Mannheim der Universität Heidelberg; Universitätsklinikum, Theodor-Kutzner-Ufer 1-3, 68167, Mannheim, Deutschland.
authors.forename: M S
authors.initials: MS
authors.lastname: Michel
mesh_terms: D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D057928:Intermittent Urethral Catheterization / Q000379:methods*; D008297:Male; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis* / Q000601:surgery*; D014547:Urinary Diversion / Q000295:instrumentation* / Q000379:methods*; D016476:Urinary Reservoirs, Continent
keywords: Anal diversion; Bladder, small capacity; Children and adolescent; Continent cutaneous diversion; Sphincter defects