The effect of temporary cutaneous diversion on ultimate bladder function.

Abstract

We evaluated the effect of temporary cutaneous diversion on bladder function in cases of various congenital uropathies. The clinical courses of patients who underwent reversal of vesicostomy or pyelostomy/ureterostomy in a 7-year period were reviewed. Indications for diversion included azotemia, massive hydronephrosis, high grade reflux and/or incomplete bladder emptying. Mean age at diversion was 15 weeks. Overall 75 cases were evaluated (posterior urethral valves in 31, neurogenic bladder in 16, reflux in 14, the syndrome of vertebral defects, anal atresia, tracheoesophageal fistula with esophageal atresia, and radial and renal anomalies in 8 and other in 6). Of 55 patients who underwent undiversion by direct closure only 2 required later augmentation for bladder/renal deterioration. Excluding the myelomeningocele patients on clean intermittent catheterization 45 of 46 who underwent direct closure were able to void spontaneously with acceptable post-void residuals. Urodynamics in 22 cases revealed normal bladder capacity at pressures below 30 cm. water in 19 (86%) after direct closure. We conclude that after a period of defunctionalization approximately 75% of children will have essentially normal bladder function. The frequency of bladder augmentation varied from 54% in patients with myelomeningocele to 14% in those with vesicoureteral reflux. This observation suggests that the need for bladder augmentation in the remaining patients is more related to the effect of the primary pathological condition on the detrusor rather than the diversion itself.