Applications of Ureterosigmoidostomy in Bladder Exstrophy
Until 1994, 95 patients with bladder exstrophy and 20 with incontinent epispadias were operated upon at our department. During the last years more and more exstrophycripples were referred to our institution after primary treatment elsewhere. Thus a total of 56 of the 104 patients had a secondary treatment after failure or unsatisfactory treatment. In contrast to many other institutions, our standard procedure was primary ureterosigmoidostomy and, since 1990 it is completely replaced by a modification of it, the sigma rectum pouch (Mainz Pouch II). After failed primary bladder closure and in patients with short or pathological ureters or insufficient anal sphincter function, we prefer an ileocaecal pouch (Mainz Pouch I). In patients with a dilated upper urinary tract we perform an colonic conduit with the option of conversion into a continent urinary diversion.
104 patients could be followed, two of whom died in the meantime, of causes not related to urinary diversion. Mean followup after the first operation was 16.7 years.
At the latest follow-up 52 had a rectal reservoir, 31 a Mainz pouch I, 15 a colonic conduit and 6 a sling plasty (incontinent epispadias) or modified Young Dees procedure. Upper urinary tract remained stable in 98%, 95%, 96% and 100% respectively. Complete day and night time continence: rectal reservoirs 94%, Mainz pouch I 97% and mod. Young Dees/sling plasty 50%.
As the sigma rectum pouch (Mainz pouch II) is the primary treatment of choice at our institution, this report will focus on our clinical experience in detail. Between 1990 and 1994 the Mainz pouch II was performed in 87 patients (20% with bladder exstrophy or incontinent epispadias). Early complication rate was 6.9%, in 9.6% late complications were followed by intervention. The overall rate of stenosis at ureteral implantation was 7.2%. 94% of the patients were continent day and night.
KeywordsUrinary Diversion Clean Intermittent Catheterisation Bladder Augmentation Continence Rate Bladder Exstrophy
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