Continent urinary diversion and the exstrophy- XXXX complex.

@entity1 @entity3930 @entity3226 @entity1494 @entity1973 @entity7891 @entity7890
PURPOSE: The use of continent urinary reservoirs has gained wide acceptance, particularly in urinary reconstruction in @entity1 with a small capacity or @entity1973 . When augmentation cystoplasty is combined with clean intermittent catheterization, @entity1 are often able to achieve continence with low intravesical filling pressures and renal preservation. Often this approach requires fashioning a continent cutaneous stoma, which remains the most challenging aspect of continent urinary reservoirs. We analyzed our experience with continent diversion in @entity1 with exstrophy- @entity7890 to determine complications and long-term results. MATERIALS AND METHODS: We performed a retrospective database review of 704 cases of exstrophy- @entity7890 . Medical records were then used to identify those @entity1 who had undergone creation of a continent urinary reservoir. Charts were reviewed to determine initial diagnosis, augmentation technique, continence mechanism, age, preoperative and postoperative bladder capacity, continence status and complications. RESULTS: Of the 91 @entity1 identified (68 male, 23 female) who had undergone continent urinary diversion classic @entity1494 was present in 80, @entity7891 in 8, complete @entity3930 in 2 and @entity7890 in 1. The most common techniques for augmentation and continent diversion were ileocystoplasty (41 @entity1 [45%]) and sigmoid cystoplasty (30 [33%]), respectively. Appendix was used in 67 @entity1 (74%) and variants of the Mitrofanoff procedure using segments of tapered ileum or ureter were used to create a continent stoma in 10 (11%). Bladder neck transection was performed in 59 @entity1 (65%). Mean age at augmentation and continent diversion was 8 years (range 2 to 25), with a mean preoperative bladder capacity of 77 cc (15 to 220). Mean followup was 6 years (range 6 months to 12 years). Of the 91 @entity1 85 (93%) were continent with clean intermittent catheterization per stoma. Of these 85 @entity1 13 required anticholinergics and alpha-agonists to achieve continence. Six @entity1 (7%) were incontinent after the procedure. Analysis of bladder capacity measurements after augmentation and continent diversion revealed that mean postoperative volume and mean volume increase were 404 cc (range 250 to 640) and 524%, respectively. The most common complications were @entity3226 formation (24 @entity1 [26%]) and stomal stenosis (21 [23%]). @entity3226 recurred in 9 @entity1 and stomal stenosis in 3. Other less common complications were vesicourethral fistula (3 @entity1 ) and a small bladder perforation (2). CONCLUSION: Augmentation and continent diversion procedures can increase the functional capacity of the small contracted noncompliant exstrophic bladder, and allow the vast majority of @entity1 to achieve continence and preserve renal function. @entity3226 and stomal stenosis pose the most significant long-term complications in these @entity1 .
