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Bladder Augmentation, Undiversion and Continent Urinary Diversion in Children Using the Mainz Pouch Technique

  • M. Stöckle
  • J. W. Thüroff
  • H. Riedmiller
  • P. Alken
  • R. Hohenfellner
Part of the Clinical Practice in Urology book series (PRACTICE UROLOG)

Abstract

Encouraged by the low morbidity and high degree of subjective contentedness achieved in adult patients who had undergone bladder augmentation or continent urinary diversion using the Mainz pouch, we began applying the same technique with increasing frequency in children. Initial disease in a series of 11 children treated with this technique consisted of functional or morphological iatrogenic bladder loss in 6, neurogenic bladder dysfunction caused by myelomeningocele in 4 and failed reconstruction of bladder exstrophy in 1. Of these, seven children received bladder augmentation, combined with undiversion in two cases. The remaining four children, who had suffered from appliance problems related to a wet stoma (ureterocutaneostomy, three; colonic conduit, one), received a Mainz pouch to create a continent urinary diversion. The main reasons for reoperation in this patient group were incontinence or problems with the care of a wet urostomy. In six patients, hydronephrosis, reflux or recurrent pyelonephritis had already involved the upper urinary tract. The preoperative details of the 11 children are summarised in Table 25.1. To illustrate the problems found in these children, two patients are described in detail:
  1. 1.

    Patient M.B. (Case No. 2) Male child born 1981, who developed spastic diplegia of the lower limbs after postnatal sepsis following premature birth. In his home country, a transuretero- ureterocutaneostomy had been performed for an unknown indication shortly after birth. Some months later the left ureter was reimplanted into the bladder using the Politano-Leadbetter technique leaving the ureteroureterostomy in place. The patient developed bilateral reflux (see Fig. 25.1a: case no. 4), hydronephrosis and a shrunken bladder with permanent incontinence (see Fig. 25.1b). After bladder augmentation in 1986 the patient was continent and learned to void his bladder without residual urine. Postoperative intravenous pyelogram (IVP) showed a significant decrease in renal dilatation (see Fig. 25.1c).

     
  2. 2.

    Patient L.J. (Case No. 11) A 12-year-old male born with bladder exstrophy. Bladder reconstruction immediately after birth had failed. After another bladder reconstruction at the age of 3 years the patient developed bilateral hydronephrosis, which was treated by transuretero- ureterocutaneostomy some months later. Stomal position was in the midline of the lower abdomen. An adequate appliance of this urostomy had never been possible, and the patient had worn nappies constantly. Reoperation to change the transuretero-ureterocutaneostomy to a continent ileocaecal pouch was perfomed in June 1986. Three weeks after the operation the patient learned to empty the continent pouch by self-catheterisation without problems.

     

Keywords

Urinary Diversion Bladder Augmentation Bladder Exstrophy Bilateral Hydronephrosis Spastic Diplegia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • M. Stöckle
  • J. W. Thüroff
  • H. Riedmiller
  • P. Alken
  • R. Hohenfellner

There are no affiliations available

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