THE EFFECT OF TEMPORARY CUTANEOUS DIVERSION ON ULTIMATE BLADDER FUNCTION

We evaluated the effect of temporary cutaneous diversion on bladder fu nction in cases of various congenital uropathies. The clinical courses of patients who underwent reversal of vesicostomy or pyelostomy/urete rostomy in a 7-year period were reviewed. Indications for diversion in cluded azotemia, massive hydronephrosis, high grade reflux and/or inco mplete bladder emptying. Mean age at diversion was 15 weeks. Overall 7 5 cases were evaluated (posterior urethral valves in 31, neurogenic bl adder in 16, reflux in 14, the syndrome of vertebral defects, anal atr esia, tracheoesophageal fistula with esophageal atresia, and radial an d renal anomalies in 8 and other in 6). Of 55 patients who underwent u ndiversion by direct closure only 2 required later augmentation for bl adder/renal deterioration. Excluding the myelomeningocele patients on clean intermittent catheterization 45 of 46 who underwent direct closu re were able to void spontaneously with acceptable post-void residuals . Urodynamics in 22 cases revealed normal bladder capacity at pressure s below 30 cm. water in 19 (86%) after direct closure. We conclude tha t after a period of defunctionalization approximately 75% of children will have essentially normal bladder function. The frequency of bladde r augmentation varied from 54% in patients with myelomeningocele to 14 % in those with vesicoureteral reflux. This observation suggests that the need for bladder augmentation in the remaining patients is more re lated to the effect of the primary pathological condition on the detru sor rather than the diversion itself.