Outcomes of incontinent ileovesicostomy in the pediatric patient.

Ching CB, Stephany HA, Juliano TM, Clayton DB, Tanaka ST, Thomas JC, Adams MC, Brock JW, Pope JC
J Urol. 2014 191 (2): 445-50

PMID: 23954583 · DOI:10.1016/j.juro.2013.08.008

PURPOSE - Ileovesicostomy is a reconstructive option in complex urological cases but pediatric specific outcomes are lacking. We report our results with pediatric ileovesicostomy.

MATERIALS AND METHODS - We retrospectively evaluated patients younger than 18 years undergoing incontinent ileovesicostomy at Vanderbilt University. History, urinary tract management and operative course were reviewed in the electronic medical record. Particular attention was given to immediate and long-term postoperative complications.

RESULTS - Nine patients underwent incontinent ileovesicostomy between 2000 and 2013 at a mean age of 10.3 years (range 1.4 to 15.5). Surgical indication was sequelae of neurogenic or nonneurogenic neurogenic bladder (such as infection or worsening hydronephrosis) in 5 patients, reversal of vesicostomy in 3 and closure of cloacal exstrophy in 1. All 9 patients were thought incapable of reliable clean intermittent catheterization due to family unwillingness, poor social support or patient refusal. Median followup was 11.5 months (mean 48.2, range 1.3 to 144.8). Immediate postoperative complications included ileus requiring total parenteral nutrition and a wound infection in 1 patient. Long-term complications included urinary tract infection in 2 patients (febrile in 1 and positive culture for foul smelling urine in 1), stomal issues in 2 and temporary urethral leakage in 1. Constipation affected 3 children in long-term followup (all with neurogenic bowel preoperatively). Postoperative creatinine was stable or improved in all patients.

CONCLUSIONS - Ileovesicostomy is a viable approach in children left with few other options, particularly those who are noncompliant or physically/socially unable to handle catheterization. This operation can help keep such patients out of diapers.

Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

MeSH Terms (20)

Adolescent Child Child, Preschool Comorbidity Cystostomy Female Humans Ileostomy Infant Intermittent Urethral Catheterization Male Meningomyelocele Postoperative Complications Reconstructive Surgical Procedures Retrospective Studies Treatment Outcome Urinary Bladder, Neurogenic Urinary Diversion Urinary Incontinence Urodynamics

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