Urinary diversion in early childhood: Indications and outcomes in the exstrophy patients

Nima Baradaran, Andrew Stec, Ming Hsien Wang, Raimondo Maximilian Cervellione, Jordan Luskin, John Phillip Gearhart

Research output: Contribution to journalArticle

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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)191-195
Number of pages5
JournalUrology
Volume80
Issue number1
DOIs
StatePublished - Jul 2012

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Urinary Diversion
Bladder Exstrophy
Hydronephrosis
Urinary Tract Infections
Catheterization
Urinary Bladder
Intermittent Urethral Catheterization
Colon
Databases
Kidney

ASJC Scopus subject areas

  • Urology

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Urinary diversion in early childhood : Indications and outcomes in the exstrophy patients. / Baradaran, Nima; Stec, Andrew; Wang, Ming Hsien; Cervellione, Raimondo Maximilian; Luskin, Jordan; Gearhart, John Phillip.

In: Urology, Vol. 80, No. 1, 07.2012, p. 191-195.

Research output: Contribution to journalArticle

Baradaran, Nima ; Stec, Andrew ; Wang, Ming Hsien ; Cervellione, Raimondo Maximilian ; Luskin, Jordan ; Gearhart, John Phillip. / Urinary diversion in early childhood : Indications and outcomes in the exstrophy patients. In: Urology. 2012 ; Vol. 80, No. 1. pp. 191-195.
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