Research Information System
Journal of Urological Surgery, vol.13, no.1, pp.6-10, 2026 (ESCI, Scopus, TRDizin)
Objective: Lower urinary tract dysfunction in pediatric patients can lead to reduced bladder capacity, high intravesical pressures, hydronephrosis, renal deterioration, and incontinence. While bladder augmentation with clean intermittent catheterization is the standard approach, some patients are unsuitable candidates or experience failure. In these cases, continent urinary diversion using the modified Indiana pouch (IP) may provide protection of the upper urinary tract and social continence. Although the IP procedure has been extensively studied in adults, long-term data in pediatric populations remain limited. We present our 23-year single-center experience with pediatric-onset IP urinary diversion. Materials and Methods: We retrospectively reviewed medical records of all patients undergoing IP diversion between January 1996 and January 2019. Twelve patients received the procedure; one adult with post-traumatic pelvic injury was excluded, leaving 11 with pediatric-onset pathology. Data collected included demographics, indication for surgery, perioperative complications, renal function, hydronephrosis, continence status, stone events, and long-term complications. Patients were followed with ultrasonography, biochemistry, and clinical evaluation every 3-6 months. Descriptive analysis was performed. Results: Median age at surgery was 15 years (range 7-28), and median follow-up was 122 months (20-243). Indications included bladder exstrophy (n=9), neurogenic bladder secondary to radiotherapy for rhabdomyosarcoma (n=1), and complex urogenital anomaly with bilateral renal dysplasia (n=1). Early complications included five febrile urinary tract infections (45%), one late urinary tract infection, and three cases of hemorrhage requiring transfusion. Hydronephrosis improved in 66% of patients. Median preoperative glomerular filtration rate (excluding transplant cases) was 112 mL/min/1.73 m² (27.8-129), declining to 71.1 (20-123) at final follow-up; three patients developed chronic kidney disease, but none required dialysis. Nine patients (82%) achieved both daytime and nighttime continence, one achieved daytime continence only, and one remained incontinent. Stones developed in 7 patients (63%), requiring 16 surgical procedures: 5 open, 7 endoscopic, and 4 percutaneous. One open procedure resulted in pouch-skin fistula. Ostomy revision was required in three patients. No patient developed metabolic acidosis, B12 deficiency, or secondary malignancy. Conclusion: The IP is a safe and effective long-term option for pediatric-onset lower urinary tract dysfunction, providing renal preservation and high continence rates. Stone formation is a frequent late complication, highlighting the importance of lifelong irrigation, surveillance, and multidisciplinary follow-up.