Indications for Cutaneous Diversion in Modern Paediatric Urology
Abstract Purpose The aim of this study was to describe patient demographics of children undergoing cutaneous diversion, the types of surgery performed, the indications and complications. Material and Methods A retrospective cohort study was performed from 1995 to 2007. Our Hospital Trust database, Nurse Specialist records and the Spina Bifida registry identified children having undergone cutaneous diversion. Case note review was carried out to identify patient demographics, type of operation and indications for surgery and complications. Results Thirty-nine patients were identified; 22(56%) male and 17(44%) female. Underlying medical conditions were neuropathic bladder 29 (74%)); bladder exstrophy 5 (13%)) and bladder outlet obstruction 5 (13%)). Median age at operation was 7 years with a range of 4 days to 19.75 years. Thirty children (77%) underwent ileal conduit formation. Ureterostomy and sigmoid conduits were formed in 6 (15%) and 2 (5%) respectively. The table below shows indications for surgery. One patient died in the immediate peri-operative period. Two patients required major re-operative surgery for bowel obstruction and nephro-enteric fistula. Twenty per cent of patients experienced difficulties using appliances. Table 1 . Social Psychological Improved quality of life Failure of previous surgery Deteriorating renal function Reconstructive surgery not possible 5 10 5 4 13 1 Conclusions Cutaneous diversion continues to be a useful strategy in the management of selected patient groups with urinary problems.