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The Role of Bladder Augmentation in Undiversion
vention yvas seen in l and 6 months poetopf,n?.·· tively in another. Both types of intestine seem well suited for ureters, After procedures an aUCH> c,..H)UUULI<; intestinal segment offers a :reasonable alternative to classical :repair or diversion. 1iJ.G.F. 4 figures, l table, 10 references
Editorial comment. Doctor Crooks died suddenly at the age of 36. This paper illustrates hls abilities and the consequent loss to our specialty, as well as to his many friends. The success of undiversion with ileocecal cystoplasty or a tapered ileal segment is again demonstrated. L.R.K Ileal Conduit Urinary Diversion in Children. An Assessment of the Long-Term Results
J. D.
ORR,
J. E. G. SHAND, D. A. K WATTERS AND I. S.
Department of Paediatric Surgery, Western General Hospital, Edinburgh
KIRKLAND,
Brit. J. Urol., 53: 424-427 (Oct.) 1981 The authors report on 43 children who underwent ileal conduit urinary diversion. Of these 43 children 34 had myelomeningocele and 4 had exstrophy of the bladder. The '"'''ua.uu.u,; children underwent diversion for miscellaneous reasons. The length of was from 4 to 22 yearn, with an followup of 15 yearso There was an eaxly 0v,,,,,.,·0wuwu 16 per cent, which compares favorably to other series. Hr,w,,,,,q long-term complications shmived that 49 of 80 «ormc""' at risk (61 per cent) showed deterioration. Stomal stenosis occurred in 14 patients and required a total of 27 stomal revisions. Urinary tract infection occurred in 31 cases (71 per cent). However, the authors could not designate any single factor as being responsible for renal deterioration. D.K.M. 5 tables, 27 references
The Role of Bladder Augn1entation in Undiversion dren's Hospital and cine, rnai,r.tnano Indiana
un,,u.,au,y
true fo:r you.Ilg
2.nd those \Vith
''""n'"'''v" in iNhom ir1tern1ittent catheterization is used. Pa~""n"tw·;,r,t :renal failure will lw.Ye a
acidosis that usually can be tieatecL Whether c:c;:;,c,:':'.~tc on the un.derhrm,e nJechar.ds1n. Most in this g-,oup have ex:pen,2:ncei:t the maintenance and u,,,,.,,,,.~,,u i.t-nprovement attention to detail is rP,rmn·s,ri the nnPr,a'nvP and long-term 5 3
Editorial comment The cases presented in this report are interesting and the nn,Pcc,it,rm is innovative. In case 1 the terminal ileum was anastomosed to the stump of the urethra, continence being provided an intussuscepted ileocecal valve with the cecum serving as the bladder. Intermittent catheterization was used to empty the bladder. This is a major advancement, since it allows even patients whose bladder is small or has been removed to be considered for undiversion. The same intussusception of the valve often was used in patients undergoing undiversion by more conventional ileocecal cystoplasty, without obstruction. This ---·---,,-- seems more reliable in plicated or the ileum u1<,u0uun;; the pressure at which fluid flows in the cecum. This should occur at 10 to 25 cr.(L water within the µ,u,yc,,u,via;,,e- range of pressure iE the upper tract or some of the plication sutures should be removed. The many advantages of ""''"'""'"cif,o,p"""'".Y are well discussed in the report, which indicates the need for a large, low pressure reservorr 1n n"'"•1n,,., with Wr<)ll,emc bladder who will be staying with the use of intennittent catheterization and the feasibility of anti.reflux ureternl anastomosis to the cecum, It also has become my favorite method of undiversion, even in some instances in which dilated ureters reach the bladder because of the greater of the anti:reflux mechanism and the of at the urnteroileal anastomosis siteo
L.R.K
J. Ped. Surg., 16: 790-798 (Dec.) 1981
There were 29 pa.tumts in age from 1 to 24 years who to fa.cilitate undiversion. underwent bladder Eighteen had deformities and nP11-c,e;u,,m,r 10 had contracted ary to chronic and l with ureterostorny and 1 had cr.1Xonic Cecal and sigmoid segments were used" A ce,co,cy:stc)piasty done in 17 patients and sigmoid cystoplasty in lo The "'"·ua.111111;; 11 patients had patch cystoplasty, using ileum in 6 and sigmoid in 5. In 10 patients procedures were done on the bladder neck or urethra to ensure continence. Renal function remained stable or improved in 25 patients. Four were considernd failures and 2 of these required rediversion. Hyperchloremic acidosis has been noted in 8 cases and treatment has been necessary in 5. Seventeen patients (59 per cent) are considered totally and acceptably dry and 8 are partially dry but 4 were unacceptably wet, including the 2 who were rediverted. Three patients underwent an operation for intestinal obstruction. Eight patients required reoperation on the bladder neck for incontinence. Unless the augmented bladder is dependably emptied period-
PREOPERATIVE .AND POSTOPERATIVE
THERAPY
Mannitol is used of renal fa.lime and in the treatment of acute cereacute respiratory distress mnnrt·rmn and acute and also to prevent uu,•.iwi=.,u,t during dialysis. When in.fused intravenously mannitol cannot traverse the cell membrane, remains in equal concentration in plasma and interstitial fluid and, by osmotic activity, mobilizes intracellular water that migrates to the extracellular space. In persons with normal renal function 80 per cent of the mannitol is excreted by the kidneys, and the remainder is eliminated slowly by metabolic conversion and with bile. Mannitol intoxication is a possible complication in patients with renal failure. F,W<~,,~c,,i~,
Editorial comment. Doctor Crooks died suddenly at the age of 36. This paper illustrates hls abilities and the consequent loss to our specialty, as well as to his many friends. The success of undiversion with ileocecal cystoplasty or a tapered ileal segment is again demonstrated. L.R.K Ileal Conduit Urinary Diversion in Children. An Assessment of the Long-Term Results
J. D.
ORR,
J. E. G. SHAND, D. A. K WATTERS AND I. S.
Department of Paediatric Surgery, Western General Hospital, Edinburgh
KIRKLAND,
Brit. J. Urol., 53: 424-427 (Oct.) 1981 The authors report on 43 children who underwent ileal conduit urinary diversion. Of these 43 children 34 had myelomeningocele and 4 had exstrophy of the bladder. The '"'''ua.uu.u,; children underwent diversion for miscellaneous reasons. The length of was from 4 to 22 yearn, with an followup of 15 yearso There was an eaxly 0v,,,,,.,·0wuwu 16 per cent, which compares favorably to other series. Hr,w,,,,,q long-term complications shmived that 49 of 80 «ormc""' at risk (61 per cent) showed deterioration. Stomal stenosis occurred in 14 patients and required a total of 27 stomal revisions. Urinary tract infection occurred in 31 cases (71 per cent). However, the authors could not designate any single factor as being responsible for renal deterioration. D.K.M. 5 tables, 27 references
The Role of Bladder Augn1entation in Undiversion dren's Hospital and cine, rnai,r.tnano Indiana
un,,u.,au,y
true fo:r you.Ilg
2.nd those \Vith
''""n'"'''v" in iNhom ir1tern1ittent catheterization is used. Pa~""n"tw·;,r,t :renal failure will lw.Ye a
acidosis that usually can be tieatecL Whether c:c;:;,c,:':'.~tc on the un.derhrm,e nJechar.ds1n. Most in this g-,oup have ex:pen,2:ncei:t the maintenance and u,,,,.,,,,.~,,u i.t-nprovement attention to detail is rP,rmn·s,ri the nnPr,a'nvP and long-term 5 3
Editorial comment The cases presented in this report are interesting and the nn,Pcc,it,rm is innovative. In case 1 the terminal ileum was anastomosed to the stump of the urethra, continence being provided an intussuscepted ileocecal valve with the cecum serving as the bladder. Intermittent catheterization was used to empty the bladder. This is a major advancement, since it allows even patients whose bladder is small or has been removed to be considered for undiversion. The same intussusception of the valve often was used in patients undergoing undiversion by more conventional ileocecal cystoplasty, without obstruction. This ---·---,,-- seems more reliable in plicated or the ileum u1<,u0uun;; the pressure at which fluid flows in the cecum. This should occur at 10 to 25 cr.(L water within the µ,u,yc,,u,via;,,e- range of pressure iE the upper tract or some of the plication sutures should be removed. The many advantages of ""''"'""'"cif,o,p"""'".Y are well discussed in the report, which indicates the need for a large, low pressure reservorr 1n n"'"•1n,,., with Wr<)ll,emc bladder who will be staying with the use of intennittent catheterization and the feasibility of anti.reflux ureternl anastomosis to the cecum, It also has become my favorite method of undiversion, even in some instances in which dilated ureters reach the bladder because of the greater of the anti:reflux mechanism and the of at the urnteroileal anastomosis siteo
L.R.K
J. Ped. Surg., 16: 790-798 (Dec.) 1981
There were 29 pa.tumts in age from 1 to 24 years who to fa.cilitate undiversion. underwent bladder Eighteen had deformities and nP11-c,e;u,,m,r 10 had contracted ary to chronic and l with ureterostorny and 1 had cr.1Xonic Cecal and sigmoid segments were used" A ce,co,cy:stc)piasty done in 17 patients and sigmoid cystoplasty in lo The "'"·ua.111111;; 11 patients had patch cystoplasty, using ileum in 6 and sigmoid in 5. In 10 patients procedures were done on the bladder neck or urethra to ensure continence. Renal function remained stable or improved in 25 patients. Four were considernd failures and 2 of these required rediversion. Hyperchloremic acidosis has been noted in 8 cases and treatment has been necessary in 5. Seventeen patients (59 per cent) are considered totally and acceptably dry and 8 are partially dry but 4 were unacceptably wet, including the 2 who were rediverted. Three patients underwent an operation for intestinal obstruction. Eight patients required reoperation on the bladder neck for incontinence. Unless the augmented bladder is dependably emptied period-
PREOPERATIVE .AND POSTOPERATIVE
THERAPY
Mannitol is used of renal fa.lime and in the treatment of acute cereacute respiratory distress mnnrt·rmn and acute and also to prevent uu,•.iwi=.,u,t during dialysis. When in.fused intravenously mannitol cannot traverse the cell membrane, remains in equal concentration in plasma and interstitial fluid and, by osmotic activity, mobilizes intracellular water that migrates to the extracellular space. In persons with normal renal function 80 per cent of the mannitol is excreted by the kidneys, and the remainder is eliminated slowly by metabolic conversion and with bile. Mannitol intoxication is a possible complication in patients with renal failure. F,W<~,,~c,,i~,