Our Summary

This research paper discusses the different ways doctors can reroute urine flow in children, a procedure known as ‘urinary diversion’. This is typically done for serious bladder problems. Technological advancements have reduced the necessity for surgery, but it’s still a crucial solution in certain cases. There are many factors to consider when deciding which type of urinary diversion is right for a child. Also, these patients need ongoing care from a urologist who specializes in children’s urinary systems, and later on, from one who treats adults. The article provides an in-depth look at the methods most commonly used by these pediatric urologists.

FAQs

  1. What are the different options available for pediatric urinary diversion?
  2. How has the necessity for surgical intervention changed due to advances in expectant management?
  3. Why is lifelong follow-up with a urologist necessary after pediatric urinary diversion?

Doctor’s Tip

One helpful tip a doctor might tell a patient about urinary diversion surgery is to carefully follow post-operative instructions, including proper care of the surgical site, monitoring for signs of infection, and attending all follow-up appointments with their urologist. It is important for patients to communicate any concerns or changes in their symptoms to their healthcare provider promptly. Additionally, maintaining a healthy lifestyle, including staying hydrated and following a balanced diet, can help optimize recovery and overall health following urinary diversion surgery.

Suitable For

Patients who may be recommended for urinary diversion surgery typically have conditions such as:

  1. Congenital anomalies of the genitourinary system, such as bladder exstrophy or cloacal exstrophy
  2. Neurogenic bladder dysfunction, such as spinal cord injury or spina bifida
  3. Recurrent urinary tract infections that do not respond to conservative treatments
  4. Bladder cancer or other malignancies requiring removal of the bladder
  5. Intractable bladder pain or interstitial cystitis that does not respond to conservative treatments

It is important for patients and their families to work closely with a pediatric urologist to determine the most appropriate type of urinary diversion surgery for their specific condition and needs. Long-term follow-up with a urologist is essential to monitor for any potential complications and ensure optimal outcomes.

Timeline

Before urinary diversion surgery:

  • Patient is evaluated by a pediatric urologist to determine the need for urinary diversion.
  • Various diagnostic tests are performed to assess the patient’s condition and determine the most appropriate type of diversion.
  • Patient and family are educated about the procedure, potential risks, and expected outcomes.
  • Surgical team plans the procedure, including choosing the appropriate type of diversion.

After urinary diversion surgery:

  • Patient undergoes the surgical procedure to create the diversion, which may involve removing all or part of the bladder.
  • Patient stays in the hospital for a period of time to recover from the surgery and learn how to manage the diversion.
  • Patient and family receive education on caring for the diversion, including emptying and cleaning the pouch or stoma.
  • Patient may experience temporary discomfort, pain, and changes in urinary function as they adjust to the diversion.
  • Patient requires lifelong follow-up with a pediatric urologist and eventually an adult urologist to monitor the diversion, manage complications, and make any necessary adjustments.

What to Ask Your Doctor

Some questions a patient should ask their doctor about urinary diversion surgery may include:

  1. What are the different types of urinary diversion surgery available and which one would be most suitable for me?
  2. What are the potential risks and complications associated with urinary diversion surgery?
  3. How long is the recovery process and what can I expect during the recovery period?
  4. Will I need to make any lifestyle changes or modifications after the surgery?
  5. How often will I need to follow up with my doctor after the surgery?
  6. What are the long-term effects of urinary diversion surgery and how will it impact my quality of life?
  7. Are there any alternative treatments or options available besides urinary diversion surgery?
  8. What is the success rate of urinary diversion surgery in patients with my condition?
  9. How experienced is the doctor in performing urinary diversion surgeries and what is their success rate?
  10. Are there any support groups or resources available for patients undergoing urinary diversion surgery?

Reference

Authors: Browning JD, Stephany HA. Journal: Urol Clin North Am. 2018 Feb;45(1):123-132. doi: 10.1016/j.ucl.2017.09.013. PMID: 29169445