THE MODIFIED RECTAL BLADDER (THE AUGMENTED AND VALVED RECTUM) FOR URINE DIVERSION IN CHILDREN

Objectives. Urinary diversion is usually the procedure of choice for c hildren having complicated primary closure for bladder exstrophy. We i ntroduce the modified rectal bladder as a low pressure and functionall y isolated rectal reservoir as a bladder substitute for these cases. M ethods. Modified rectal bladder urinary diversion was done on 15 child ren as a low pressure and functionally isolated rectal reservoir via t he adoption of sigmoid intussuscepted valve and the rectal patching wi th detubularized sheet of ileum. Fourteen of these children are curren tly evaluable, with follow-up ranging from 16 to 72 months (median 55 months). All of them are subjected to thorough history-taking, clinica l examination, laboratory and radiologic investigations, and urodynami c study. Results. A high rate of urinary continence was achieved and s o far the upper urinary tract and the metabolic status were preserved. Reflux to the colon and kidneys was prevented. Urine samples from the renal pelvis through percutaneous needle aspiration revealed sterile cultures in 82% of the renal units (23 of 28). Conclusions. Our result s demonstrate the distinct advantages of the modified rectal bladder o ver the conventional methods of urinary diversion to the rectum or the abdominal reservoirs coupled to the skin via continent catheterizable stomas.