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Early clinical experience with continent urinary diversion.

BACKGROUND
Alternatives to cutaneous diversion have included continent urinary diversion and replacement cystoplasty. Five-year experience with continent diversion is reported.


METHODS
Between 1989 and 1994, 29 patients underwent continent urinary diversion. Of these, 24 patients underwent Indiana pouch procedures and five patients had a Mitrofanoff-type procedure. All have now been followed up for at least 12 months.


RESULTS
The continence rate for the Indiana pouch group was 23/24 (96%) and the mean capacity was 648 mL (range 300-1400). There were nine (37.5%) early postoperative complications, only three of which (12.5%) required surgical revision. The late complication rate was 35.5% (7/22), and 18.2% (4/22) of the patients underwent re-operation. Stomal stenosis occurred in two patients in whom the stoma was situated in the right iliac fossa, whereas all 12 stomas sited at the umbilicus had no stomal problem. Four of the five patients having Mitrofanoff procedures were continent, but these patients had higher rates of early and late complications.


CONCLUSIONS
From this experience, the Indiana pouch urinary diversion appears to be superior to the Mitrofanoff procedure when continent diversion is indicated. An umbilical stoma site is optimal.