Outcomes of incontinent ileovesicostomy in the pediatric patient.
J Urol
; 191(2): 445-50, 2014 Feb.
Article
en En
| MEDLINE
| ID: mdl-23954583
ABSTRACT
PURPOSE:
Ileovesicostomy is a reconstructive option in complex urological cases but pediatric specific outcomes are lacking. We report our results with pediatric ileovesicostomy. MATERIALS ANDMETHODS:
We retrospectively evaluated patients younger than 18 years undergoing incontinent ileovesicostomy at Vanderbilt University. History, urinary tract management and operative course were reviewed in the electronic medical record. Particular attention was given to immediate and long-term postoperative complications.RESULTS:
Nine patients underwent incontinent ileovesicostomy between 2000 and 2013 at a mean age of 10.3 years (range 1.4 to 15.5). Surgical indication was sequelae of neurogenic or nonneurogenic neurogenic bladder (such as infection or worsening hydronephrosis) in 5 patients, reversal of vesicostomy in 3 and closure of cloacal exstrophy in 1. All 9 patients were thought incapable of reliable clean intermittent catheterization due to family unwillingness, poor social support or patient refusal. Median followup was 11.5 months (mean 48.2, range 1.3 to 144.8). Immediate postoperative complications included ileus requiring total parenteral nutrition and a wound infection in 1 patient. Long-term complications included urinary tract infection in 2 patients (febrile in 1 and positive culture for foul smelling urine in 1), stomal issues in 2 and temporary urethral leakage in 1. Constipation affected 3 children in long-term followup (all with neurogenic bowel preoperatively). Postoperative creatinine was stable or improved in all patients.CONCLUSIONS:
Ileovesicostomy is a viable approach in children left with few other options, particularly those who are noncompliant or physically/socially unable to handle catheterization. This operation can help keep such patients out of diapers.Palabras clave
BMI; CIC; DLPP; MACE; Malone antegrade continence enema; RBUS; TPN; UTI; body mass index; clean intermittent catheterization; detrusor leak point pressure; neurogenic; pediatrics; renal bladder ultrasound; surgical stomas; total parenteral nutrition; urinary bladder; urinary diversion; urinary tract infection; urinary tract infections
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Derivación Urinaria
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Incontinencia Urinaria
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Cistostomía
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Ileostomía
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Procedimientos de Cirugía Plástica
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Límite:
Adolescent
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Idioma:
En
Revista:
J Urol
Año:
2014
Tipo del documento:
Article