Catheterisable Continent Urinary Diversion (Mitrofanoff Principle) - Clinical Experience and Psychological Aspects

Abstract

48 Mitrofanoff principles (MTR) were performed on 46 patients (male : female ratio, 30 : 16) with a mean age of 9.1 years (range 2.5 to 24 years). The primary diagnoses were neurogenic bladder in 11, infravesical obstruction in 7 and bladder exstrophy-epispadias complex in 28 patients. The most common type of conduit was appendix (38 cases); other conduits were constructed from the ileum (seven) and ileocaecum (one). In two cases with bladder substitution the uterine tube and tubularised bladder stump were used as perineal MTR. 33 of the 46 children underwent augmentation cystoplasty in conjunction with the MTR procedure. The Malone procedure for antegrade colonic enema (ACE) was performed at the same stage with MTR in eight cases. To achieve continence, bladder neck reconstruction was performed in 32 patients and the bladder neck was closed in four patients during the same operation and MTR procedure. The mean follow-up period was 28.7 months (range one month to 57 months). To assess the psychological aspects of the MTR procedure, the Rosenberg Self-Esteem Scales were completed by 12 children older than eight years of age. Nine patients had problems with the MTR (19.5 %). Three appendiceal MTR had strictures at the skin level, 2 of which needed minor surgical revisions. A mucocele formation at the skin level of an appendix was removed successfully. We did not observe any complaints among the other appendiceal conduits. All the tapered ileum conduits were difficult to catheterise, and 1 of them had a leakage from the stoma. None of the three transversely tubularised ileum MTRs had problems with catheterisation or leakage. A stricture of the conduit from the uterine tube was observed. 36 of the 42 patients are now continent, giving a ratio of 86 %. The results of the Rosenberg Self-Esteem Scales revealed that there was an increase in the percentage of patients with high self-esteem, and a decrease in depressive feelings after the MTR procedure. We conclude that the MTR procedure provides excellent continence, offers good prospects of a socially acceptable life with increased self-esteem, and the appendix seems to be the ideal organ for continent urinary diversion, with the transverse tubularised ileal tube as a second choice.

Is continent diversion using the Mitrofanoff principle a viable long‐term option for adults requiring bladder replacement?

“…In cases where the appendix was unavailable, ileum has been shown to be a suitable alternative. Although some studies have reported higher stomal complication rates with ileal catheterizable conduits, other studies have shown favourable results [2,3,12]. In the present series, three of eight ileal conduits developed stomal stenosis compared with 12 of 20 appendiceal conduits (not statistically significant).…”

The efferent segment in continent cutaneous urinary diversion: a comprehensive review of the literature

“…The length, diameter, and the overall wall tension of the embedded tube determine the closure pressure and the degree of continence [2]. Several types of tissues are used to create flap valves, preferably the vermiform appendix [3][4][5][6][7][8][9].…”

“…Most studies were retrospective, single-institutional or even single-surgeon case series (LoE, mostly 3; Fig. 8 Fallopian tubes, foreskin, skin flaps, stomach, and bladder wall [3][4][5][6]8,9,28,29]. Without a doubt, the appendix flap valve is the most popular variation of the Mitrofanoff procedure.…”

Traitements chirurgicaux des hyperactivités vésicales neurologiques

“…La continence urinaire et l'utilisation de la stomie varient de 80 à 100 % [41,[52][53][54][55]. La qualité de vie des patients opérés, quand elle est recherchée, est améliorée [55,56].…”