Reply by the Authors

Abstract

We agree with Dr. Gerharz that it is difficult to evaluate long-term metabolic consequences from urinary diversion. It is interesting that of the five references he quotes, two are letters expressing his opinion, one is a review article, one included a follow-up of only 3.7 years in patients after bladder augmentation in whom one would not expect to find significant bony complications, and only one is an original report with reasonable follow-up. In that study, 242 patients were identified as potentially at risk, but it was only possible to report on 123. As we referenced, a decrease in linear bone growth has been reported in contemporary series, 1 Gros D.A. Dodson J. Lopatin U. et al. Decreased linear bone growth associated with intestinal bladder augmentation in children with bladder exstrophy. J Urol. 2000; 164: 917-920 Abstract Full Text Full Text PDF PubMed Google Scholar as has reduced bone mineral density. 2 Hafez A.T. McLorie G. Gilday D. et al. Long-term evaluation of metabolic profile and bone mineral density after ileocystoplasty in children. J Urol. 2003; 170: 1639-1642 Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar However, the risk of long-term bony complications is low when patients are followed up closely, and those who are missed from follow-up are most at risk. We should, therefore, be careful when interpreting nonconsecutive case series. Re: Hautmann RE, Abol-Enein H, Hafez K, et al: Urinary diversion. Urology 69(suppl): 17–49, 2007UrologyVol. 72Issue 1PreviewThe international panel of experts has to be congratulated on its extremely ambitious and exhaustive work on “Urinary Diversion” commissioned by the World Health Organization and the Société Internationale d'Urologie. It is a tragedy, however, that most so-called consensus papers, regardless of the authors' excellence, are out of date when they are finally published. The most obvious reason for this well-known phenomenon is the inevitable delay between the time of the (ideally, systematic) literature search and the printing of the journal. Full-Text PDF