THE APPLICATION OF CONTINENT URINARY STOMAS TO BLADDER AUGMENTATION OR REPLACEMENT IN THE FAILED EXSTROPHY RECONSTRUCTION

Objective To determine the application and success of continent urinar y stomas in the failed bladder exstrophy reconstruction. Patients and methods A total of 35 patients underwent construction of a continent u rinary stoma during bladder replacement or bladder augmentation betwee n 1987 and 1993. The continent stoma was constructed with appendix (19 patients), tapered ileum (2), Benchekroun (12), Indiana (1) and Mainz type stoma (1). Results Three patients required revision of their con tinent stoma, one for incontinence and two for difficulty in catheteri zation. Overall, 95% experienced daytime continence on an intermittent catheterization regimen, while 90% were dry at night. The upper tract remained normal in 34 of 35 patients. Conclusions While the Benchekro un technique is reliable in producing continence, difficulty with cath eterization has been a chronic problem due to stomal stenosis. Our pos itive experience with using the appendix as a catheterizable conduit i nto either the bladder template or bowel segment has led us to prefer this method of continent stoma construction in the patient with a fail ed exstrophy. In the absence of an appendix, our preference is a taper ed ileal segment. The failed exstrophy reconstruction can be salvaged with a continent stoma and substitution or augmentation cystoplasty in most patients, thus avoiding urinary diversion.