Efficacy and safety of continent anal urinary diversion for complicated bladder exstrophy in children by using modified Duhamel's procedure.

Abstract

BACKGROUND:

A high proportion of children with bladder exstrophy will continue to suffer from urinary incontinence and a miserable life even after a well-performed staged reconstruction in specialized centers. Most of those children usually have a normal anal sphincter allowing construction of a neobladder from the rectum, so they are continent without an abdominal stoma, and do not require frequent catheterization, which greatly contribute to a favorable body image.

OBJECTIVE:

In this study a modified Duhamel's rectal pouch done for 19 children, with implication of suitable stapler adopted to construct a rectal bladder with a non-refluxing urterorectostomy, there is a theoretical advantage in our procedure of avoiding a mix of urine and feces. All patients were followed for up to 6 years (2-8 years) for efficacy, safety, subsequent renal complications, and surveillance for any rectal neoplastic changes in this new diversion.

STUDY DESIGN:

Assessment of electrolytes, acid base balance, and renal function were carried out regularly and all data were analyzed using the SPSS 9.0.1 statistical package and compared using a paired t test; data were considered significant if p < 0.05. Proctoscopy was performed 6 monthly in the first year then annually thereafter, and at any time if there was any rectal bleeding.

RESULTS:

In this group of patients, follow-up revealed no neoplastic changes in the rectal bladder, deterioration in renal function, or major electrolytes disturbance. They can hold up to 400 mL (350-550 mL) of urine and all are continent during the daytime with an emptying frequency of 3-5 h; three patients had infrequent (4 episodes/month) nocturnal enuresis; and four cases developed pyelonephritis controlled with medical treatment.

CONCLUSION:

The continent rectal bladder created by using the principles of the Duhamel pull-through is feasible, easy to perform, successful in the immediate short term with low complications after 6 years of follow-up and appropriately accepted by the children and their families with marked improvement in quality of life regarding continence; longer-term follow-up is requested to rule out rectal neoplastic changes. A comparative review of the complications, patient's acceptance, and longer-term follow-up with other well-known procedures, such as Mainz II, is required.

• Authors: Mohamed A Baky Fahmy, Alae A Al Shenawy, Sameh M Shehata
• Journal: Journal of pediatric urology (J Pediatr Urol) Vol. 11 Issue 5 Pg. 254.e1-6 (Oct 2015) ISSN: 1873-4898 [Electronic] England
• PMID: 25964196 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Topics

• Anal Canal (surgery)
• Bladder Exstrophy (complications, surgery)
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Humans
• Male
• Retrospective Studies
• Time Factors
• Treatment Outcome
• Ureteroscopy
• Urinary Bladder (surgery)
• Urinary Diversion (methods)
• Urinary Incontinence (diagnosis, etiology, surgery)
• Urinary Reservoirs, Continent