Is continent urinary diversion feasible in children under five years of age?

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Barbosa, Luiz L. [UNIFESP]
Liguori, Riberto [UNIFESP]
Ottoni, Sergio L. [UNIFESP]
Barroso Jr, Ubirajara [UNIFESP]
Ortiz, Valdemar [UNIFESP]
Macedo Junior, Antonio [UNIFESP]
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Purpose: To review our clinical experience with urinary continent catheterizable reservoir in children under five years of age. Materials and Methods: A total of 23 patients (16 males, 7 females) with a median age of 3.64 years were evaluated. Among these, 6 (26.08%) had a posterior urethral valve, 9 (39.13%) myelomeningocele, 4 (17.39%) bladder exstrophy, 2 (8.69%) genitourinary rabdomyosarcoma, 1 (4.34%) had spinal tumor and 1 (4.34%) an ano-rectal anomaly. Results: Perioperative complications were observed in four patients consisting of one febrile urinary tract infection, one partial operative wound dehiscence, one partial stomal dehiscence and one vesico-cutaneous fistula after a secondary exstrophy repair. The overall long-term complications rate was 40.90% and consisted of two stomal stenoses (9.09%), one neobladder mucosal extrusion (4.54%), three neobladder calculi (13.63%) and persistence of urinary incontinence in three patients (13.63%). The overall surgical revision was 36.36% and final continence rate was 95.45% with mean follow-up of 39.95 months Conclusion: Continent urinary diversion is technically feasible even in small children, with acceptable rates of complications.
International braz j urol. Sociedade Brasileira de Urologia, v. 35, n. 4, p. 459-466, 2009.