LONG TERM OUTCOME OF RECTAL BLADDER USING MODIFIED DUHAMEL TECHNIQUE IN THE MANAGEMENT OF BLADDER EXSTROPHY IN DUHOK CITY, IRAQ

Qadir Mohammed Salih Qadir

Qadir Mohammed Salih Qadir Assistant Professor, Consultant Pediatric Surgeon, Dept of Surgery, College of Medicine, University of Duhok

Keywords: Duhamel’s pull-through, Bladder exstrophy, Urinary diversion

Abstract

https://doi.org/10.31386/dmj.2025.19.2.2

Background: Urinary diversion continues to present considerable challenges in urological
surgery. The Heitz-Boyer-Houvelac uretero-rectostomy, first described in 1912 and later
validated experimentally by Shaw in 1937, remains a foundational approach. Bladder
exstrophy, a severe congenital anomaly affecting the lower abdominal wall, urinary tract,
genitalia, and pelvic bones, is a principal indication for urinary diversion. Despite advances in
reconstructive techniques, approximately 10% of exstrophic bladders are of inadequate
capacity and 30% of patients remain incontinent following staged reconstruction. This study
aimed to evaluate the efficacy and safety of urinary diversion using a modified Duhamel
uretero-rectostomy technique in the management of urinary incontinence associated with
bladder exstrophy, focusing on renal preservation, continence outcomes, cosmetic results, and
long-term complications.

Patients and Methods: A retrospective review (2009–2014) followed by a prospective
analysis (2014–2021) was conducted on 27 patients (19 males, 8 females; mean age 6.8 years)
treated by a single surgeon at two centers in Duhok, Iraq. Postoperative assessments included
renal function, serum electrolytes, urinary pH, ultrasound, proctography, and annual
proctoscopy with rectal biopsy.

Results: Mean operative duration was four hours, with uneventful recovery in all cases. Rectal
pouch capacity increased significantly to a mean of 330 mL at one year. Continence improved
progressively, and urinary tract infection occurred in four patients, with one requiring surgical
correction. No histopathological abnormalities were observed.

Conclusion: The modified Duhamel uretero-rectostomy provides a reliable, technically
straightforward, and functionally effective option for urinary diversion in bladder exstrophy,
demonstrating durable long-term outcomes and a low complication rate

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