Document Detail


Urinary diversion in children and adolescents with neurogenic bladder: the Mainz experience. Part III: Colonic conduit.
MedLine Citation:
PMID:  15864655     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
After the failure of conservative treatment of neurogenic bladders, urinary diversion has to be considered. For patients with chronic renal failure, severe dilated upper urinary tracts with deterioration of the renal function and those who are not able to perform a self-catheterization, the colonic conduit diversion is our therapy of choice. In this part of the study, we investigate the long-term safety of our concept for these patients in regard to protecting the upper urinary tracts. Between 1968 and 2002, colonic conduit urinary diversion was performed in 88 patients, in most of them in the era before continent diversion. Overall, 11 patients with a colonic conduit were converted to bladder substitution or continent cutaneous diversion during the follow-up period. These patients are no longer included in the long-term follow-up of colonic conduit patients. Of the 77 patients with colonic conduit diversion, 21 patients were not available for follow-up: 11 were deceased and 10 were lost to follow-up. Three of the deaths were related to nephrological complications in patients who already had impaired renal function before conduit diversion. An average follow-up of 21.8 years (2-32.7; median 23.8 years.) is available in 56 patients with 99 RUs (6 solitary kidneys, 7 nephrectomies). Five non-functioning kidneys were removed after recurrent pyelonephritis and two kidneys with pyonephrosis. Ureter stenoses were corrected in 6% of the RUs. As compared to preoperatively, the upper urinary tracts remained stable or improved in 97/99 RUs at the latest follow-up. A revision of the stoma was necessary in 16% (conduit elongation n =2, stenosis n =7) and calculi formations were treated in 8% of the RUs. For patients with chronic renal failure or who are unable to perform a catheterization of a continent stoma, the colonic conduit is a safe alternative in the long run.
Authors:
Raimund Stein; Christoph Wiesner; Rolf Beetz; Manfred Schwarz; Joachim W Thüroff
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Publication Detail:
Type:  Journal Article     Date:  2005-04-27
Journal Detail:
Title:  Pediatric nephrology (Berlin, Germany)     Volume:  20     ISSN:  0931-041X     ISO Abbreviation:  Pediatr. Nephrol.     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-06-16     Completed Date:  2005-10-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8708728     Medline TA:  Pediatr Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  932-6     Citation Subset:  IM    
Affiliation:
Department of Urology, Johannes Gutenberg University School of Medicine, Langenbeck Strasse 1, 55131 Mainz, Germany. Stein@urologie.klinik.uni-mainz.de
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MeSH Terms
Descriptor/Qualifier:
Acid-Base Equilibrium
Adolescent
Adult
Child
Child, Preschool
Colon / surgery*
Humans
Infant
Kidney / physiopathology
Postoperative Period
Reoperation
Retrospective Studies
Urinary Bladder, Neurogenic / complications,  physiopathology,  surgery*
Urinary Diversion* / adverse effects

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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