The urinary diversion in children with bladder exstrophy and epispadias: alternative to primary bladder closure.

The main objective of this study was to evaluate the outcome of management of bladder exstrophy and epispadias with continent urinary diversion. A total of 15 children, 10 females and 5 males underwent continent urinary diversion at Kilimanjaro Christian Medical Centre (KCMC) between 1985 and 1997. Their ages ranged between one month and 13 years with an average of 5.4 years. Eight (53%) of them had exstrophy epispadias complex, 4 (27%) had incontinent epispadias, 2 (13%) presented with neurological conditions and 1 (7%) had traumatic destruction of the bladder neck and urethra. Seven (47%) had Mainz pouch II procedure, 6 (40%) underwent the classical ureterosigmoidostomy while 2 (13%) had appendicovesicostomy. The mean duration of follow up was 3.2 years. Three patients developed mild non-progressive hydronephrosis, which required no surgical intervention. One patient with a solitary kidney developed ureteral stenosis at the implantation site that was undiverted. Metabolic acidosis was well compensated with none of the patients requiring sodium bicarbonate supplements. Only one patient had night soiling that required wearing of diapers. Our experience with continent urinary diversion in children with other benign bladder conditions has been favourable and in our view, it offers a viable treatment method in children with exstrophy epispadia complex.