Pediatric urinary tract reconstruction using intestine

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Pediatric urinary tract reconstruction using intestine. / Clementson Kockum, Christina; Helin, Ingemar; Malmberg, Lars; Malmfors, Gerhard.

In: Scandinavian Journal of Urology and Nephrology, Vol. 33, No. 1, 1999, p. 53-56.

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Clementson Kockum, C, Helin, I, Malmberg, L & Malmfors, G 1999, 'Pediatric urinary tract reconstruction using intestine', Scandinavian Journal of Urology and Nephrology, vol. 33, no. 1, pp. 53-56. https://doi.org/10.1080/003655999750016285

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Clementson Kockum, Christina ; Helin, Ingemar ; Malmberg, Lars ; Malmfors, Gerhard. / Pediatric urinary tract reconstruction using intestine. In: Scandinavian Journal of Urology and Nephrology. 1999 ; Vol. 33, No. 1. pp. 53-56.

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TY - JOUR

T1 - Pediatric urinary tract reconstruction using intestine

AU - Clementson Kockum, Christina

AU - Helin, Ingemar

AU - Malmberg, Lars

AU - Malmfors, Gerhard

PY - 1999

Y1 - 1999

N2 - OBJECTIVE: To analyse the outcome of urinary tract reconstruction in children. MATERIAL AND METHODS: Fifteen children with bladder exstrophy or neurogenic bladder, 4-18 years old, were followed in accordance with a predetermined program for bladder augmentation (13 pat) or continent urinary reservoir (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 reconstructions, two artificial sphincters, one sling plasty and one fistula closure with subsequent bladder neck injection were required. Bladder volumes 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 glomerular impairment in all. Progressive parenchymal lesions were seen in combination with abundant mucus, infections and calculi only. Growth and bowel function was unaffected. Bone mineral density showed overall increase; some low values were not consistent between investigations. CONCLUSIONS: Urinary tract reconstruction in children results in continence and regression of reflux. Growth, bone mineralization and renal function are unimpaired during 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 can only be determined by continuous close monitoring over an extended period of time. ABBREVIATIONS: Voiding cystourethrogram (VCUG), dimercapto-succinic acid (DMSA), Chrome51-Ethylenediaminetetraacetic acid (Cr-EDTA), single photon absorption (SPA), bone mineral content (BMC), bone mineral density (BMD), dual photon x-ray absorption (DEXA), glomerular filtration rate (GFR), urinary tract infection (UTI), immunoglobulin G (IgG), clean intermittent catheterization (CIC) and subureteral teflon injection (STING).

AB - OBJECTIVE: To analyse the outcome of urinary tract reconstruction in children. MATERIAL AND METHODS: Fifteen children with bladder exstrophy or neurogenic bladder, 4-18 years old, were followed in accordance with a predetermined program for bladder augmentation (13 pat) or continent urinary reservoir (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 reconstructions, two artificial sphincters, one sling plasty and one fistula closure with subsequent bladder neck injection were required. Bladder volumes 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 glomerular impairment in all. Progressive parenchymal lesions were seen in combination with abundant mucus, infections and calculi only. Growth and bowel function was unaffected. Bone mineral density showed overall increase; some low values were not consistent between investigations. CONCLUSIONS: Urinary tract reconstruction in children results in continence and regression of reflux. Growth, bone mineralization and renal function are unimpaired during 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 can only be determined by continuous close monitoring over an extended period of time. ABBREVIATIONS: Voiding cystourethrogram (VCUG), dimercapto-succinic acid (DMSA), Chrome51-Ethylenediaminetetraacetic acid (Cr-EDTA), single photon absorption (SPA), bone mineral content (BMC), bone mineral density (BMD), dual photon x-ray absorption (DEXA), glomerular filtration rate (GFR), urinary tract infection (UTI), immunoglobulin G (IgG), clean intermittent catheterization (CIC) and subureteral teflon injection (STING).

KW - children

KW - urinary diversion

KW - myelomeningocele

KW - bladder exstrophy

U2 - 10.1080/003655999750016285

DO - 10.1080/003655999750016285

M3 - Article

VL - 33

SP - 53

EP - 56

JO - Scandinavian Journal of Urology

JF - Scandinavian Journal of Urology

SN - 2168-1813

IS - 1

ER -