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.

Ureterosigmoidostomy: a useful procedure of internal urinary diversion in selected patients.

OBJECTIVES: To determine the quality of life and complications in patients who underwent ureterosigmoidostomy for various indications. DESIGN: Case series. SETTING: Urological clinic. SUBJECT: Nine patients who had good anal sphincter control and no upper urinary tract dilation, underwent urinary diversion via ureterosigmoidostomy by antireflux ureteral anastomosis. They were followed up for not less than five years. MAIN OUTCOME MEASURES: Incidence of symptomatic urinary tract infections, metabolic derangement; occurrence of upper urinary tract dilation, frequency of emptying the rectum, incidence of soiling and quality of life. RESULTS: The group as whole, experienced a total of 69 years of life with ureterosigmoidostomy diversion. There were no serious post operative complications. There were two incidences of urinary tract infection in the same patients who also had upper urinary tract dilation. Metabolic derangements and gross incontinence did not occur. All patients had satisfactory quality of life. CONCLUSIONS: In under developed nations where patients cannot afford external appliances and the surgeon's skill for continent diversion is lacking, our results show that in properly motivated patients with a good functional anal sphincter and who are free of ureteral dilation, ureterosigmoidostomy can be a successful form of urinary diversion without the psychological and social burdens of a wet cutaneous stoma.

Urethral mucosa prolapse in young girls.

Two cases of urethral prolapse in young girls are presented. One patient had urethral bleeding and the other presented with acute urinary retention. In Tanzania, to the best of our knowledge, urethral prolapse as a cause of acute urine retention in girls has not been reported. The management is also discussed.