Biomaterial Database

Urinary diversion in bladder exstrophy and incontinent epispadias: 25 years of experience. 1995

R Stein, and M Fisch, and M Stöckle, and R Hohenfellner

Department of Urology, University of Mainz School of Medicine, Germany.

OBJECTIVE To determine the optimal surgical approach in achieving complete urinary continence with preservation of the upper urinary tract in the exstrophy-epispadias complex we reviewed the records of patients treated at our institution. METHODS From 1968 to July 1994, 115 patients with bladder exstrophy/incontinent epispadias were treated of whom followup was available for 104 and 2 died of causes unrelated to urinary diversion. Mean followup is 16.7 years. In 43 of the 102 patients surgery was primarily performed at our institution (urinary diversion in 39, a modified Young-Dees procedure in 1 and sling plasty in 3). In another 59 patients urinary diversion was done secondarily after therapy elsewhere (bladder closure/bladder neck reconstruction in 34 and failed urinary diversion with incontinence in 22). Urinary diversion was performed in 49 patients, a Young-Dees procedure in 7 and genital reconstruction alone in 3. RESULTS The present continence rates are 96% for the rectal reservoir, 97% for the Mainz pouch I and 67% for the modified Young-Dees augmentation. Upper tracts have remained stable and no bowel neoplasms have developed. CONCLUSIONS Rectal reservoirs represent our urinary diversion of choice. After failed reconstruction/insufficient anal sphincter a Mainz pouch I is constructed and when the upper tract has deteriorated a colon conduit is created.

UI	MeSH Term	Description	Entries
D001746	Bladder Exstrophy	A birth defect in which the URINARY BLADDER is malformed and exposed, inside out, and protruded through the ABDOMINAL WALL. It is caused by closure defects involving the top front surface of the bladder, as well as the lower abdominal wall; SKIN; MUSCLES; and the pubic bone.	Bladder Extrophy,Exstrophy Of Bladder,Exstrophy of the Bladder,Urinary Bladder Exstrophy,Bladder Exstrophies,Bladder Extrophies,Exstrophies, Bladder,Exstrophies, Urinary Bladder,Exstrophy, Bladder,Exstrophy, Urinary Bladder,Extrophies, Bladder,Extrophy, Bladder,Urinary Bladder Exstrophies
D004842	Epispadias	A birth defect due to malformation of the URETHRA in which the urethral opening is above its normal location. In the male, the malformed urethra generally opens on the top or the side of the PENIS, but the urethra can also be open the entire length of the penis. In the female, the malformed urethral opening is often between the CLITORIS and the labia, or in the ABDOMEN.	Epispadia
D005500	Follow-Up Studies	Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.	Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012809	Colon, Sigmoid	A segment of the COLON between the RECTUM and the descending colon.	Sigmoid,Sigmoid Colon
D014519	Ureterostomy	Surgical formation of an opening in the ureter for external drainage of the urine; cutaneous route utilizes a ureteral orifice emerging through the skin.	Ureterostomies
D014547	Urinary Diversion	Temporary or permanent diversion of the flow of urine through the ureter away from the URINARY BLADDER in the presence of a bladder disease or after cystectomy. There is a variety of techniques: direct anastomosis of ureter and bowel, cutaneous ureterostomy, ileal, jejunal or colon conduit, ureterosigmoidostomy, etc. (From Campbell's Urology, 6th ed, p2654)	Ileal Conduit,Conduit, Ileal,Conduits, Ileal,Diversion, Urinary,Diversions, Urinary,Ileal Conduits,Urinary Diversions
D014549	Urinary Incontinence	Involuntary loss of URINE, such as leaking of urine. It is a symptom of various underlying pathological processes. Major types of incontinence include URINARY URGE INCONTINENCE and URINARY STRESS INCONTINENCE.	Incontinence, Urinary
D016476	Urinary Reservoirs, Continent	Structures which collect and store urine and are emptied by catheterization of a cutaneous stoma or internal diversion to the urethra. The reservoirs are surgically created during procedures for urinary diversion.	Colonic Urinary Reservoirs,Continent Urinary Reservoirs,Colonic Urinary Reservoir,Continent Urinary Reservoir,Reservoir, Colonic Urinary,Reservoir, Continent Urinary,Reservoirs, Colonic Urinary,Reservoirs, Continent Urinary,Urinary Reservoir, Colonic,Urinary Reservoir, Continent,Urinary Reservoirs, Colonic
D016896	Treatment Outcome	Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.	Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes