Urinary diversion in children with mainly exstrophy and epispadias: alternative to primary bladder closure

OBJECTIVE: To review the long term outcome of children who underwent urinary diversion for various non-malignant conditions and to assess the suitability of urinary diversion as an alternative treatment to primary bladder closure in cases of bladder exstrophy epispadias complex. DESIGN: A retrospective study. SETTING: Institute of Urology, Moshi, Tanzania. SUBJECTS: Fifteen children who underwent urinary diversion for various non-malignant conditions between 1985 and 1997. RESULTS: Fifteen children underwent urinary diversion for: exstrophy epispadias complex (n = 12) neurogenic bladder (n = 2) and trauma (n = 1). Seven children underwent Mainz pouch II diversion, six had classical ureterosigmoidostomy and two had appendicovesicostomy. One patient with a solitary kidney developed ureteral stenosis at the implantation site and was undiverted. Metabolic acidosis was well compensated with none of the patients requiring sodium bicarbonate supplements. All the patients except one were continent. CONCLUSION: We conclude that continent urinary diversion in children offers a viable alternative method for children with bladder exstrophy epispadias complex.