Reconstruction of previously diverted urinary tracts in children

Abstract

HE PAST DECADE has seen increased effort directed toward repair of the urinary tracts of children with severe obstructed uropathy. 1-7 Such repair has proved successful in most instances despite the complexity of these problems and the difficulty of the surgery. Many youngsters however, have had some type of urinary diversion in the past before current techniques were developed, or more recently in the belief that their renal function was too much reduced to prevent any approach except permanent diversion. Diversion methods have included ileal conduit, cutaneous vesicostomy, cutaneous ureterostomy, suprapubic tube cystostomy, and tube nephrostomy. Long-term follow-up of such children has been dismal in some cases. Although there may be initial improvement, all too often it is followed by gradual deterioration from continuing low-grade infection, s Improved results in various pediatric obstructive uropathies have prompted us to attempt reconstruction of certain children who had been previously diverted. This paper will describe an experience with undiversion of the urinary tract in ten children with the following types of drainage: ileal loop in three (for 6, 6, and 5 yr); suprapubic cystostomy in three (for 6, 3, and 2 yr); nephrostomy in two (for 10 and 9 yr); ureterostomy in one (for 9 yr); and both nephrostomy and cystostomy in one (for 16 yr).