The Ileal Conduit in Thirty-Five Children
RALPH A. STRAFFON, M.D.
Department of Urology
RUPERT B. TURNBULL, M.D.
Department of General Surgeryand
ROBERT D. MERCER, M.D.
Department of Pediatrics
CHILDREN who require urinary diversion rarely have malignant disease, therefore, with the possibility of a normal life span, long-term results are of vital importance. Of the surgical procedures employed, ureterosigmoidostomy has been used most frequently, particularly in patients with exstrophy of the bladder. However, the sequela of chronic pyelonephritis, hydronephrosis, and electrolyte imbalances after ureterosigmoidostomy, have prompted searches for other methods of urinary diversion.
In 1956 Bricker1 reported the use of an isolated ileal segment as a conduit for urine. Since then, other authors2–5 have presented their experience with the ileal conduit. These reports have dealt primarily with the ileal conduit in adults, with little emphasis on its use in children.
Ileocystoplasty6 and cutaneous vesicostomy7 are alternative methods that require an intact bladder, and closure of the vesical neck when incontinence is present. These procedures have been utilized in only a few children to date,8 and the long-term effectiveness remains to be determined.
This report presents our experience with the ileal conduit constructed in 35 children.
The ileal conduit has been used in three groups of patients in our series: (l) 9 children with exstrophy of the bladder, (2) 23 children with autonomous neurogenic bladder with incontinence, and (3) 3 children with obstructive lesions that produce severe hydronephrosis and renal insufficiency. The ileal conduit has been used by other surgeons in children who have epispadias and incontinence, severe trauma to the bladder, congenital absence of abdominal musculature, or when there is a bladder neoplasm such as sarcoma botryoides . . .