LONG-TERM RESULTS OF URETEROSIGMOIDOSTOMY IN CHILDREN WITH BLADDER EXSTROPHY

Purpose: We evaluated long-term results of patients with bladder exstr ophy who underwent ureterosigmoidostomy. Materials and Methods: Of 4 w omen and 23 men monitored at our institution 16 (59%) underwent primar y diversion by ureterosigmoidostomy, while 11 (41%) underwent primary bladder closure or an ileal conduit procedure before conversion to ure terosigmoidostomy. Average followup after ureterosigmoidostomy was 17 years. Results: Significant upper urinary tract changes developed in 1 8% of the patients. Metabolic acidosis was well compensated in most pa tients but 2 had problems with urinary retention leading to hyperammon emia and acidosis. Of the 19 patients monitored with biennial colonosc opy benign polyps were removed in 4. Daytime continence was achieved i n 92% of cases and nighttime continence in 58%.Conclusions: Our experi ence with ureterosigmoidostomy in children with bladder exstrophy has been favorable through long-term followup. With proper imaging, metabo lic surveillance, biennial colonoscopy and nonsteroidal anti-inflammat ory drugs we offer ureterosigmoidostomy as a viable alternative for pa tients with small bladders.