Bladder Augmentation, Undiversion and Continent Urinary Diversion in Children Using the Mainz Pouch Technique
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).
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.
KeywordsUrinary Diversion Bladder Augmentation Bladder Exstrophy Bilateral Hydronephrosis Spastic Diplegia
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