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The first 25 slides, exactly as they appear. The full deck has 71 content slides.
Paediatric Surgery
Continent Urinary Diversion
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
9 sections · 71 slides
Overview
- What we are going to build up, step by step
The Core Idea
Replacing a failed bladder with a pouch that stores urine safely
- What problem are we actually solving?
- The four rules every reservoir must obey
- Why bowel, and why this is a lifelong commitment
- Augment first, remove the bladder last
Choosing the Right Child
Evaluation, selection, and the team around the patient
- Who sits at the table for this decision
- The work-up: history, imaging, and bloods
- Why kidney function is the gatekeeper
- The nursing evaluation — quietly decisive
- The key question: can the child cooperate?
- The nurse as lifelong point of contact
Getting Ready for Surgery
Imaging, laboratory baselines, and the bowel-prep debate
- Radiology and laboratory baselines
- The bowel-preparation debate — a change of practice
- A gentler modern regimen
The Four Families of Reservoir
Which piece of gut, and why
- Choosing the building material
- The four basic reservoir types
- The take-home before the details
- Ureterosigmoidostomy: the abandoned original
- The cancer warning at the urine-stool interface
- Why the cancer risk is the deal-breaker
- MAINZ pouch: mixing ileum and cecum
- MAINZ II: a safer rectosigmoid pouch
- Kock pouch: continence by nipple valves
- Composite gastroileal pouch
- How the Indiana pouch is built
- Indiana pouch: the ileocecal valve as a cork
Plumbing In the Ureters
Building a one-way valve so urine never washes back to the kidneys
- Why anti-reflux is non-negotiable in children
- The flap-valve principle
- Tunnelling a ureter into the taenia coli
- Technique 1: taenia coli tunnel (for colon reservoirs)
- Technique 2: Abol-Enein & Ghoneim serosal-lined tunnel
- Technique 3: nipple valve (no muscle tunnel needed)
The Emptying Channel
A small, continent tube the patient catheterizes
- Why a channel, and the Mitrofanoff principle
- Preparing the appendix as a catheterizable channel
- Appendicovesicostomy (APV): the workhorse channel
- Yang-Monti and spiral Monti: when there is no appendix
- The flap-valve that keeps the channel continent
- A well-supported channel implanted on the anterior wall
- The four S's: straight, short, supple, supported
- Stoma location and continent vesicostomy
- APV vs Monti: what the long-term Indiana data show
- Channel continence is easy; durability is the challenge
- Macedo ileal-flap channel
The Lifelong Price
Complications every CUR patient is signed up for
- The headline long-term risks
- Inadequate reservoir capacity
- Perforation: rare but the most dangerous
- Stones: a frequent and recurrent nuisance
- UTI: expect it, and rethink the signs
- Metabolic disturbance: hyperchloremic acidosis
- Vitamin B12 deficiency: the slow, silent one
- Diarrhea: the cost of taking the ileocecal valve
- Malignancy: clear only for ureterosigmoidostomy
- Bowel obstruction: harvesting gut has a downside
Putting It Together
Judgment, and where the field is heading
- Select ruthlessly
- Conclusion and future directions
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- Pediatric Surgery and Pediatric Urology