No abstract

We report the use of the Mitrofanoff principle to achieve urinary continence in 47 patients. A catheterizable channel can be used as the primary continence mechanism, or as an adjunct to ensure complete bladder emptying if urethral catheterization or voiding is inadequate. Appendico-vesicostomy was performed in 25 of 47 patients (55%). Satisfactory continence was achieved in 45 patients (96%). Bladder emptying by clean intermittent catheterization was performed in all patients. Early complications included peristomal abscess (1 patient) and small bowel obstruction (1). Late complications included difficulty with catheterization (5 patients), stomal stenosis (9) and persistent incontinence (2). Our results support use of the appendix as the catheterizable segment of choice. We describe the technique and discuss the management of complications.

No abstract

A prospective study of 18 consecutive patients undergoing unilateral, partial-thickness, distal, internal sphincterotomy for the treatment of chronic anal fissure was performed. Biopsies were taken from the base of the fissure and from the lateral muscle before division. Normal specimens were taken from the internal anal sphincter of patients undergoing abdominoperineal resection. Specimens confirmed the presence of fibrosis throughout the internal anal sphincter in patients with anal fissures, but none in controls.