Continent Urinary Diversion: 10-Year Experience Of Shriners Hospitals For Chiloren In Chicago

Abstract

Purpose: To review long-term functional results, complications, and patient satisfaction in patients with a continent catheterizable urinary diversion.Materials and Methods: A retraspective chart review and telephone satisfaction interviews were conducted. Bladder dysfunction was attributed to neuragenie bladder (n = 48: 23 spinal cord injury, 18 myelomeningocele, 4 sacral agenesis, 3 cerebral palsy), bladder exstrophy (n = 2), posterior urethral valves (n = 1), and other (n = 3). Patients underwent continent urinary dive rsion with either the Mitrafanoff principle (appe ndicovesicostomy, n = 47) or a Monti tube (ileovesicostomy, n = 8). Outcomes were assessed by chart review. Patient satisfaction was assessed by telephoneinterview and scored from 1 to 10 on a Likert-type scale.Results: Between 1992 and 2003, 54 continent urinary diversions were performed on 17 boys and 37 girls. Mean age was 15.3 years (range, 7-21 years). An umbilical stomawas created in all patients. Seventy-three percent (40/ 54) and 47% (26/ 54) underwent concomitant bladder augmentation and urethral sling procedure, respectively. Mean follow-up was 2.5 years (range, 3 months to 10 years) . Ninety-five percent (51 154) of patients we re continent, and 5% (3154) were incontinent from the umbilical stoma after one operation. All were compliant with intermittent cathet erization. Complications included bladder calculi (1 5%; 8/ 54), stomal stenosis (9%; 5/ 54), stomal bleeding (5%; 3/ 54), small bowel obstruction (2%; 1 / 54), and superficial wound dehiscence (2%; 1 /54). Seventy-three percent ( 40/ 5 4) of patients were available for telephone interview. Of these, 90% (36/ 40) reported satisfaction, and 1 0% ( 4/ 40) reported dissatisfaction; 9 3% (3 7 140) reported that they would recommend the procedure to othe rs, whereas 7% (3/ 40) would not.Conclusion: ln our se ries, continent urinary dive rsion with the Mitrafanoff principle or Monti tube is associat ed with high contine nce, compliance, and satisfaction rates and a low complication rat e. An umbilical stoma was achievable in all patie nts. Our 10-year experience is consistent with other reported series and underscores the successfullong-term outcome and durability of continent urinary diversions.