Temporary tubeless urinary diversion in children

Abstract

HE PROVISION OF ADEQUATE DRAINAGE of urine in patients with malformations of the urinary tract continues to vex the surgeon caring for the small child. There are a number of operations to restore urinary tract function, but in many situations immediate reconstruction is unwise or impossible. Opening the urinary tract above a congenital mechanical obstruction may be of little avail if there is a proximal functional obstruction. The patient may be in renal failure and unable to tolerate extensive surgery. Then, too, hydronephrosis and hydroureter can subside spontaneously if adequate drainage is provided. The primary objective of urinary diversion is to improve renal function. Such diversion should be prompt, effective, safe, and permit maximal return of renal function and decompression of the urinary tract. Objectives. Regardless of the methods used, and almost irrespective of the underlying disease, the prime objective of urinary diversion is to improved renal function. In order to accomplish this, drainage must be completely effective, the procedure should not predispose to infection, and it should not favor the formation of uniary tract calculi. As obvious as these criteria may seem, they are frequently not met. Catheters, because of their simplicity, have been widely used for drainage of the bladder or in the kidney, yet they have two very serious drawbacks: the presence of a foreign body invariably leads to infection, and the combination of infection and foreign body predisposes to calculus formation. Catheter drainage is not a satisfactory method of urinary diversion except for short-term use. Tubeless cutaneous drainage of the urinary tract is an effective method of urinary diversion. A urocutaneous stoma can be created at any level in the urinary tract and is easy to manage, especially in the small child. It makes little difference to the mother whether the diaper is worn around the flank, for example,