Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

10:18 - 10:21

S23-4

(PP)

LONG-TERM OUTCOME AFTER URINARY DIVERSION USING THE ILEOCECAL

SEGMENT IN CHILDREN AND ADOLESCENTS - THE EFFERENT SEGMENT

Marina DEUKER

, Raimund STEIN

, Allegra GROßMANN

, Patrick FAE

and Joachim W. THÜROFF

1) Johannes Gutenberg University, School of Medicine, Division of Pediatric Urology, Mainz, GERMANY - 2) Johannes

Gutenberg University, School of Medicine, Department of Urology, Mainz, GERMANY

PURPOSE

To evaluate the long-term outcome after urinary diversion using the ileocecal segment in children and adolescents with

special respect to the complication of the efferent segment.

MATERIAL AND METHODS

Between 1984 and 2008, the ileocecal segment was used in 125 children and adolescents for urinary diversion.

Indications: neurogenic bladder n=64, exstrophy-epispadias-complex n=34, malignancy n=16, various indications

n=11. In 30 patients the bladder augmentation / substitution was carried out (in 12 an additional continent cutaneous

stoma was performed) and in 95 a continent cutaneous diversion. For the efferent segment, the in situ submucosally

embedded appendix was used in 55 patients, an intussuscepted ileal nipple in 4 and other techniques in 7 patients.

RESULTS

The median follow-up was 15.8 years (0.4-28.5y). 4 patients died tumor-related, 4 due to complications from the

meningomyelocele. 41/107 patients with a continent cutaneous stoma developed a total of 81 stomal stenosis, 17

patients had multiple stenosis (2-6x). Of those with an appendiceal stoma 49% had a stenosis in contrast to 20% of

those with an intussuscepted ileal nipple (p <0.001); and 5 of the 7 with other continence mechanisms. In 37 cases

excision of the scar with reanastomosis of the bowel with the skin (recurrence rate 38%) and in 44 cases an endoscopic

incision (recurrence rate 60%) was performed. At the last follow-up 89% of the patients with an appendiceal stoma and

82% of those with an intussuscepted ileal nipple were completely continent.

CONCLUSIONS

The in situ submucosally embedded appendix and the intussuscepted ileal nipple are reliable continence mechanism in

the long term follow-up. The higher rate of stomal stenosis with the appendiceal stoma is most likely due to the smaller

diameter of the appendix. Excision of the scar is better than incision of the scar.