Mitrofanoff continent catheterizable conduits: Top down or bottom up?

Berkowitz, Jared; North, Amanda; Tripp, Ricky; Gearhart, John P.; Lakshmanan, Yegappan

doi:10.1016/j.jpurol.2008.11.003

Cited by 25 publications

(6 citation statements)

References 12 publications

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“…This contrasts with a previous observation by Berkowitz et al. where they showed that anteriorly placed CCSs are more prone to infection and hypothesized that ineffective bladder emptying can be contributory. In the author's experience, once the child and the parents were adherent to clean intermittent catheterization (CIC), the rate of symptomatic infection was not increased using either technique.…”

Section: Discussioncontrasting

confidence: 94%

Using a serosal trough for fashioning a continent catheterizable stoma: technique and outcomes

et al. 2012

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• Continent urinary diversion with bladder augmentation is an established method of providing urinary continence in children with bladder exstrophy, who are not suitable candidates or have a failed bladder neck reconstruction. Sub-mucosal implantation of the tubularized catheterizable stoma (usually the appendix) into the reservoir, with backing typically provided by either the bladder musculature or colonic taenia, is safe and highly effective in these children.• In some cases of classic bladder exstrophy and in the majority of patients with cloacal exstrophy, the ileum is used for enterocystoplasty and therefore there is no taenia to back the implanted catheterizable channel. This study describes the steps for providing a reliable flap-valve mechanism for the continent catheterizable channel using the serosal trough technique. Objectives• To evaluate the efficacy and potential complications of the serosal-trough (ST) technique for the implantation of a continent catheterizable stoma (CCS) during enterocystoplasty.• To describe the surgical technique and provide detailed illustrations. Patients and Methods• Using an institutional review board-approved departmental database, children with bladder exstrophy, born after 1990, were selected, and patients who had undergone urinary diversion with a CCS created using the ST technique were identified. • Demographic and technical characteristics, as well as the eventual clinical outcomes, were retrospectively reviewed. Results• A total of 135 patients with urinary diversion were identified, of whom 26 (13 males) had undergone CCS implantation using the ST technique. Patients included 14 classic exstrophies, 10 cloacal exstrophies, and two epispadias.• The appendix and tapered ileum were used for the creation of a CCS in 11 and 15 patients, respectively. The median (range) age at creation of a CCS was 10.7 (4.4-17.4) years. At the time of CCS creation, 21 patients underwent initial enterocystoplasty, four had repeat augmentations, and one had a CCS on a previously augmented bladder.• Ileum (mean length 18 cm) was used in 24/25 augmentations and was selected owing to lack of redundant sigmoid in 52% of patients and intraoperative surgeon preference in the remaining cases. In one case of cloacal exstrophy, a hindgut remnant was used.• In 24 (92%) cases, initial CCS resulted in complete continence of the catheterizable channel. After a median (range) of 2.5 (0.2-7.5) years' follow-up all patients were dry via intermittent catheterization. The CCS failed at postoperative months 6 and 21 and required complete revision in two cases. Conclusions• Using a ST to provide a strong backing for a catheterizable channel is an excellent option when a channel must be placed in the ileum, hindgut, or in an area of augmentation where muscular backing is not available.• The ST technique provides a reliably catheterizable tunnel, durable continence mechanism and a good success rate when creating a CCS in combination with a urinary diversion.

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Section: Discussioncontrasting

confidence: 94%

Using a serosal trough for fashioning a continent catheterizable stoma: technique and outcomes

et al. 2012

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“…We prefer the implantation of the conduit (either Mitrofanoff or Monti) on the posterior bladder wall in order to obtain the straightest path from the abdominal wall to the bladder, favouring the complete emptying of the bladder. This choice is also supported by recent findings in the literature that would suggest that there is suboptimal bladder drainage with anterior conduits, reflected by a greater risk of UTI and bladder stone formation than there is with posterior conduits . With regard to the anti‐reflux mechanism, we adopt the Lich‐Gregoir technique, which is nowadays the ‘gold standard’ in the minimally invasive setting .…”

Section: Discussionmentioning

confidence: 84%

Laparoscopic and robot‐assisted continent urinary diversions (Mitrofanoff and Yang‐Monti conduits) in a consecutive series of 15 adult patients: the Saint Augustin technique

Rey¹,

Helou

Oderda

et al. 2013

BJU International

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Objective• To present a series of 15 laparoscopic and robot-assisted Mitrofanoff and Yang-Monti vesicostomies in an adult population, and to assess the feasibility and safety of these minimally invasive approaches. Patients and Methods• Between 2009 and 2012, 15 patients underwent laparoscopic (n = 11) or robot-assisted (n = 4) construction of vesicostomy by a single surgeon (D.R.): Mitrofanoff appendicovesicostomy (n = 11) or double Yang-Monti ileal conduit (n = 4). Fourteen patients underwent concomitant augmentation enterocystoplasty.• Indications for surgery included neurogenic bladder (n = 11) and urethral dysfunction (n = 4).• The patients were evaluated postoperatively using cystography. Quality of life (QoL) was evaluated using an internally developed questionnaire. Results• All surgeries were successfully completed with no conversions. Operating time was always <5 h. The mean estimated blood loss was 150 mL and the mean follow-up was 22 months.• Early postoperative complications included deep retrovesical abscess (n = 2) and upper urinary tract infections (n = 4), and one patient had peri-operative cardiac failure.• Late postoperative complications included stomal stenosis (n = 2), persistent low-pressure bladder incontinence (n = 1) and recurrent infections (n = 1). Surgical excision of the conduit was necessary in one patient.• Postoperatively, patients showed complete bladder emptying and no leak on follow-up cystography. According to our QoL questionnaire, 13/15 patients did not regret the surgery. Conclusions• While a longer follow-up is needed to assess the durability of our results, this series shows that the laparoscopic and robot-assisted approaches for the construction of continent urinary diversions are feasible and safe in an adult population.

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“…However, others have shown no difference between the two [21]. Mitrofanoffs constructed on the posterior wall of BA, rather than the anterior walls, are thought to drain urine more efficiently and have a lower rate of UTI and stone formation [22]. The use of Mitrofanoff in the present study (all opening on the posterior wall of the BA) was not associated with an increased risk of calculi formation when compared to urethral catheterisation.…”

Section: + Modelmentioning

confidence: 47%

Bladder calculi in the augmented bladder: A follow-up study of 160 children and adolescents

Kisku

Sen

Karl

et al. 2015

Journal of Pediatric Urology

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Mitrofanoff continent catheterizable conduits: Top down or bottom up?

Cited by 25 publications

References 12 publications

Using a serosal trough for fashioning a continent catheterizable stoma: technique and outcomes

Using a serosal trough for fashioning a continent catheterizable stoma: technique and outcomes

Laparoscopic and robot‐assisted continent urinary diversions (Mitrofanoff and Yang‐Monti conduits) in a consecutive series of 15 adult patients: the Saint Augustin technique

Bladder calculi in the augmented bladder: A follow-up study of 160 children and adolescents

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