Continent Urinary Reservoir in Exstrophy/Epispadias Complex

The outcome of 15 children and young adults who underwent reconstruction of continent urinary reservoirs (CUR) from January 1987 to 1990 is presented. Ten patients were male and 5 female with an age range of 3 to 20 years. There were 13 patients with bladder exstrophy and 2 with incontinent epispadias. In 8 cases the urinary diversion was performed for an inadequate bladder capacity following successful closure (3), failed attempted closure (3), female epispadias (1) and following successful urethroplasty in 1 case of male epispadias. A tiny fibrotic bladder plate unsuitable for attempted closure was the indication for diversion in 3 patients. Faecal and urinary incontinence following ureterosigmoidostomy (2 patients) and trigonosigmoidostomy (2) was the reason to consider re-diversion in 4 previously diverted patients. In 10 patients an Indiana pouch was performed. The Mitrofanoff procedure was used in 5 cases with caecum (2), sigmoid colon (2) or transverse colon (1) as the urinary reservoir. All patients are continent on clean intermittent catheterisation with stable renal function. Three patients developed large stones within the reservoir and needed open cystolithotomy. This series supports the efficacy of CUR as an alternative procedure to traditional forms of urinary diversion in the management of selected patients with exstrophy/epispadias complex.