Ileal Conduits in Children at the Massachusetts General Hospital From 1955 to 1970

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Abstract
The 45 ileal conduits performed on children at the Massachusetts General Hospital from 1955-1963 are reviewed and compared to the 45 ileal conduits performed from 1964-1970. Late complications involving the conduits occurred in 60% of the early group and in 51% of the late group. Of the renal units judged normal pyelographically preoperatively in the early group, 77% went on to at least some deterioration, while 62% of the late group judged normal later deteriorated. Combining all renal units, 34% remained unchanged, 26% improved and 41% showed some degree of deterioration after ileal conduit urinary diversion. The late complication and renal deterioration rates seem to increase progressively with time. There was no apparent urinary obstruction in 13% of the renal units that deteriorated. Theoretical and experimental considerations indicate the reflux of infected urine as the etiology of the renal deterioration. Because of the late complications and the unacceptably high rate of renal deterioration ileal conduits are no longer performed in children. Instead every effort is made to reconstruct the urinary tract or, if urinary diversion is necessary, a colon conduit with non-refluxing ureterocolonic anastomoses is performed.