Reconstructive surgery of the urinary tract in children

Undiversion using ileocecocystoplasty in a case of retroperitoneal hemorrhage after cardiac catheterization

We performed urinary undiversion using ileocecocystoplasty in a patient who sustained bladder and ureteral necrosis secondary to transfemoral cardiac catheterization.

The use of antirefluxing intestinal segments in pediatric urinary reconstruction

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.

Vesicostomy for the temporary diversion of the urine in small children

Vesicostomy was done as a means of temporary urinary diversion in 16 children less than 3 years old. Adequate urinary drainage was not present in these children yet definitive corrective measures were not considered advisable. The good results achieved sugges that this operation is ideally suited for this purpose.

Cystoscopy in children: indications for its use in common urologic problems

The use of cystoscopy in children as part of the routine urologic evaluation in 4 diagnostic categories is evaluated for its ability to provide significant data and influence the course of management and cost effectiveness. Records of patients with hematuria, voiding dysfunction, urinary tract infection and vesicoureteral reflux were reviewed. Our analysis of these data suggests that this procedure has certain well defined indications. Its omission when these indications are not fulfilled presents the potential for considerable monetary savings without reduction in the quality of medical care.

Upper tract management when posterior urethral valve ablation is insufficient

Of 105 boys with posterior urethral valves managed during a 10-year period most were managed by primary valve ablation. However, 39 of these boys required concomitant or additional procedures to 71 massively dilated ureters because of azotemia, infection and/or progressive upper tract deterioration. In 17 boys 25 ureters could be reconstructed primarily by varying degrees of ureteral tailoring. When there was severe infection, azotemia and/or doubt as to the function of the affected renal unit, staged reconstruction was initiated by cutaneous ureterostomy. One-fourth of these ureterostomy diverted children died of azotemia despite free urinary drainage. Those who went on to have staged reconstruction, despite multiple surgical procedures, retained intact urinary systems with acceptable function.