THE SOCIAL IMPLICATIONS OF LOWER URINARY-TRACT RECONSTRUCTION PERFORMED DURING CHILDHOOD

Objective To compare the social effects of urinary diversion, undivers ion and orthotopic bladder reconstruction performed during childhood. Patients and methods Of 99 patients treated at the Wessex Centre for P aediatric Surgery between 1960 and 1993, 46 (16 with a urinary diversi on, eight with an undiversion and 22 with bladder reconstruction) were interviewed using a standardized questionnaire. Information was colle cted about the types and results of surgery, the medical support recei ved and the social effects of the different treatments. Results By day , continence or only occasional wetting was achieved in 13 patients wi th diversions, all those with undiversions and 16 of those with recons tructions. At night, 13 patients with diversions, seven with undiversi ons and 18 with reconstructions were dry or only occasionally wet. Re- operation rates were higher in those with reconstruction and undiversi on. Only five of the diversion group were satisfied with their managem ent compared to all patients in the other two groups. The social effec ts in terms of employment, schooling, independence, body image and soc ial interactions were also better in those with undiversions and recon structions. Conclusions The social effects of undiversion and bladder reconstruction were better than those following urinary diversion desp ite the higher re-operation rates and the need for a rigid regimen of post-operative care. However, the need for continuing medical support in this group of patients cannot be over emphasized, and the vital rol e of the urological nurse specialist is stressed.