Pediatric urinary tract reconstruction using intestine

Objective: To analyse the outcome of urinary tract reconstruction in childr en. Material and methods: Fifteen children with bladder exstrophy or neurog enic bladder, 4-18 years old, were followed in accordance with a predetermi ned program for bladder augmentation (13 pat) or continent urinary reservoi r (2 pat). The follow-up time was 1.7-6.3 years, median 3.7 years. Results: All were dry, though one case had occasional leaks. Three bladder neck rec onstructions, two artificial sphincters, one sling plasty and one fistula c losure with subsequent bladder neck injection were required. Bladder volume s were adequate for age at low pressures. Reflux resolved in 12/13 ureters. A boy with preoperative renal insufficiency was transplanted. Total renal function remained otherwise stable despite acidosis in one case and some gl omerular impairment in all. Progressive parenchymal lesions were seen in co mbination with abundant mucus, infections and calculi only. Growth and bowe l function was unaffected. Bone mineral density showed overall increase; so me low values were not consistent between investigations. Conclusions: Urin ary tract reconstruction in children results in continence and regression o f reflux. Growth, bone mineralization and renal function are unimpaired dur ing the first years, but irrigation of the bladder is essential to minimize the risk of urinary tract infection. However, glomerular function might be affected and the possible risk of metabolic complications in later life ca n only be determined by continuous close monitoring over an extended period of time. Abbreviations: voiding cystourethrogram (VCUG), dimercapto-succin ic acid (DMSA), Chrome(51)-Ethylenediaminetetraacetic acid (Cr-EDTA), singl e photon absorption (SPA), bone mineral content (BMC), bone mineral density (BMD), dual photon xray absorption (DEXA), glomerular filtration rate (GFR ), urinary tract infection (UTI), immunoglobulin G (IgG), clean intermitten t catheterization (CIC) and subureteral teflon injection (STING).