PEDIATRIC UROLOGY THE MODIFIED RECTAL BLADDER (THE AUGMENTED AND VALVED RECTUM) FOR URINE DIVERSION IN CHILDREN MOHAMED R. MAHRAN, M.I). AHMED M. GI-tAI.Y, M.D. KHALED Z. S[IEIR, M.D. TAREK A. EI..-I)IASTY, M.I). MOHAMt-I) A. GHONEIM, M.D. I-:rom the I)epartmems of Urology and Radiology,. t;rology and Nephrology Center, Mansoura, Egypt ABSTRACT--Objectives. Urinary diversion is usually the procedure of choice for children having complicated primary closure for bladder exstrophy. We introduce the modified rectal bladder as a low pressure and functionally isolated rectal reservoir as a bladder substitute for these cases. Methods. Modified rectal bladder urinary diversion was clone on 15 children as a low pressure and functionally isolated rectal reservoir via the adoption of sigmoid intussus- cepted valve and the rectal patching with detubularized sheet of ileum. Fourteen of these children are currently evaluable, with follow-up ranging from 16 to 72 months (median 55 months). All of them are subjected to thorough history-taking, clinical examination, laboratory and radiologic investigations, and urodynamic study. Results. A high rate of urinary continence was achieved and so far the upper urinary tract and the metabolic status were preserved. Reflux to the colon and kidneys was pre- vented. Urine samples from the renal pelvis through percutaneous needle aspiration re- vealed sterile cultures in 82% of the renal units (23 of 28]. Conclusions. Our results demonstrate the distinct advantages of the modified rectal bladder over the conventional methods of urinary diversion to the rectum or the abdomi- nal reservoirs coupled to the skin via continent catheterizable stomas. e iunctional closure of the eXSll'O- provides the ideal restoration of the tract, the theoretical advantages of are seldom achieved and urinary in- trticularly at night, remains a proh- other band, urinary diversion is ex- troversial, and a continent one is lethod of choice. Ureterosigmoidos- ,st popular form of urinary diversion .rophy patients and [avorable results rained by several investigators. ~,:~ us problems were observed with this :h as pyelonephritis, renal function and eleclrolyte imbalance. In all ~ d: February l 0, 1994, accepted (with r~:visions): .Jura" attempt to circumvent borne of these disadvan- tages, the technique ot the modified rectal blad- tier (augmenled and valved rectum) has been recently described:" Favorable resu[ts have been obtained with the procedure in adults/,.`) Herein. we report the clinical oulconle in 15 children with benign bladder conditions that required urinary diversion. MAI-ERIAL AND METI IODS t-:rom March 1987 to November 1991, the modi- fied rectal bladder has been performed in 15 chil- dren, 9 boys and 6 girls. The median age was 8.5 years (range, 3 to 12 years). The indications for urinary diversion were complicated primary clo- sure of the bladder exstrophy ill 14 patients and bladder sarconra treated by radical eystoprostatec- tomy in one. ~)LOCY" / ;\'u~,L.~az~1994 / Vcl u~: 4"~,:\::;vm ~ 5 731