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

Abstract

OBJECTIVE To audit the long‐term outcome of patients with Mitrofanoff continent urinary diversion (MUD) to inform counselling of future patients concerning the procedure. PATIENTS AND METHODS All patients who underwent MUD between 1990 and 2003 were identified. Continence, urinary tract infection (UTI), calculus formation and renal function were assessed by chart review and interviews. RESULTS Of the 29 patients identified 12 were women and 17 men with a mean (range) age of 48 (18–79) years at operation. The median (range) follow‐up was 126 (5–190) months. On questioning, 25 of 28 (89%) patients stated that they were continent. There was more than one confirmed UTI per year in two patients. Half of the patients had at least two UTIs within the follow‐up period but with no deterioration in renal function. Calculi developed in eight (29%) patients; four with bladder, three with renal and one with both renal and bladder calculi. Stomal stenosis developed in 15 (54%) patients requiring intervention at a mean (range) rate of 0.4 (0.1–2.4) episodes per year and nine ultimately required stomal reconstruction. Five (18%) patients required conversion to ileal conduit, two of these for persistent incontinence and three for recurrent stomal complications, at a mean (range) of 82 (9–140) months. CONCLUSIONS MUD is effective in offering continence with no major deterioration of renal function; however, this needs to be balanced against the need for subsequent additional interventions for stomal stenosis, stone formation and UTI on an individual basis.

Supine and upright urodynamic evaluation of incontinent ileovesicostomy in wheelchair-bound adults with neurogenic bladder

“…4,13 All patients in our cohort had low-pressure bladders in both the supine and sitting positions. A net change of 3.1 cm H 2 O (range [1][2][3][4][5][6][7][8][9][10][11][12] was noted between the two positions and was statistically significant. However, this does not appear to be clinically significant and clearly reflects low-pressure storage and emptying of the ileovesicosotmy for all patients evaluated in all positions.…”

“…5 If the urethra is severely damaged a concomitant bladder neck closure (BNC) may be needed as well. 6 The aim of urodynamics (UDS) is to make precise pressure and volume measurements, while reproducing symptoms in order to identify the underlying causes for the symptoms, and to quantify the related pathophysiological processes. 7 This group of patients spends a substantial portion of their waking hours sitting in a wheelchair.…”

Continent catheterizable vesicostomy in an adult population: Success at high costs

“…In the only series with more than 5 years of follow up the conversion rate was 18% and the mean time to conversion was 6.8 years. 17 The revision rate in our series was 29% (10/35 patients). An overview of revisions is demonstrated in Table II.…”

“…[13][14][15][16][17][18][19][20] Patient age seems to be an important factor in the number of complications and revisions. 17 In our series, age was not correlated to the complication ratio.…”

Continent Urinary Diversions in Non Oncologic Situations: Alternatives and Complications

“…Sahadevan et al reported a self-reported continence rate of 89% with a mean follow up time of 126 months [30]. Incontinence may occur through the urethra or the conduit [20,21,31,[12][13][14]17,[27][28][29][32][33][34].…”