The social implications of lower urinary tract reconstruction performed during childhood

Abstract

To compare the social effects of urinary diversion, undiversion and orthotopic bladder reconstruction performed during childhood. Of 99 patients treated at the Wessex Centre for Paediatric Surgery between 1960 and 1993, 46 (16 with a urinary diversion, eight with an undiversion and 22 with bladder reconstruction) were interviewed using a standardized questionnaire. Information was collected about the types and results of surgery, the medical support received and the social effects of the different treatments. By day, continence or only occasional wetting was achieved in 13 patients with diversions, all those with undiversions and 16 of those with reconstructions. At night, 13 patients with diversions, seven with undiversions and 18 with reconstructions were dry or only occasionally wet. Re-operation rates were higher in those with reconstruction and undiversion. Only five of the diversion group were satisfied with their management compared to all patients in the other two groups. The social effects in terms of employment, schooling, independence, body image and social interactions were also better in those with undiversions and reconstructions. The social effects of undiversion and bladder reconstruction were better than those following urinary diversion despite the higher re-operation rates and the need for a rigid regimen of post-operative care. However, the need for continuing medical support in this group of patients cannot be over emphasized, and the vital role of the urological nurse specialist is stressed.