The use of antirefluxing intestinal segments in pediatric urinary reconstruction

Abstract

Because of inadequate ureteral length or disease preventing direct ureterovesical anastomoses, antirefluxing intestinal segments were used in eight children during reconstruction of their urinary tracts. Previous urinary diversions by either ileal conduit or cutaneous ureterostomy had been done in six of the eight. In five of the children, bladder augmentation was also required because of nondistensible fibrotic bladders secondary to disuse or prior obstruction. The intestinal segments used were ileal (4), ileocecal (4), and sigmoid (1). The ileal segments were tapered along the antimesenteric border and reimplanted into the bladder with long submucosal tunnels to prevent reflux. Reflux was prevented in the ileocecal segments by plication of the normal ileocecal valve. Reflux has not developed postoperatively in any of these patients. In one patient in whom an ileal segment was used. In one patient in whom an ileal segment was used, partial obstruction occurred at the new bladder hiatus. The serum creatinine rose from 2.8 mg/dl to 3.5 mg/dl necessitating a secondary repair. Renal function and serum electrolytes have improved or remained stable in all other patients. For children who have undergone multiple previous procedures resulting in inadequate ureteral length and/or abnormal bladders, these techniques offer excellent alternatives to permanent urinary diversion.