Urodynamically Based Modification of Mitrofanoff Procedure

Abstract

This paper reviews our experience with the Mitrofanoff principle as applied in eight patients. Of four patients with post-traumatic urethral stricture, three required the appendix as continent catheterizable conduit, with a modified appendicovesical anastomosis technique-that is, without a submucosal tunnel- and in one patient, the remnant ureter of a previous simple nephrectomy was used. Of the four remaining patients, one with a hypotonic bladder and three with urethral stricture, a complete laparoscopic approach was used to perform the same modified Mitrofanoff procedure with the appendix. With a mean follow-up of 19.5 months, all patients were completely dry. Only three patients had persistently positive urine cultures, but without evidence of renal function impairment. The modified direct appendicovesical anastomosis technique reduces the operative time, has a lower complication rate, and allows us to use a laparoscopic approach with the resulting benefits of a minimally invasive surgical procedure. As shown in urodynamic tests, urinary continence is preserved.

Laparoscopic appendicovesicostomy and ileovesicostomy: A step-by-step technique description in neurogenic patients

“…Prolonged operative time was considered a potential disadvantage associated with laparoscopic approach; however, we really noted a significant improvement as much as we handle with technical issues, mainly ports positions and stoma mobilization and intraperitoneal catheterization. Our operative time was equivalent to that of other open[11] or laparoscopic series[912] and lower in comparison with robotic approaches. [13]…”

Laparoscopic tissue approximation

“…Intracorporeal FNS Antiphon et al 1999 [6] Burch colposuspension Intracorporeal FNS, mesh, clips Bauer et al 1999 [8] Pyeloplasty Endo-Stitch Cadeddu et al 1996 [10] Enterocele repair Endo-Stitch; Lapra-Ty Docimo et al 1995 [14] Gastrocystoplasty Endo-stitch Ehrlich et al 1994 [16] Vesico-ureteral re¯ux repair Intracorporeal FNS Fornara et al 1997 [17] Nephropexy Suture, tied extracorporeally Gatti et al 1999 [18] Percutaneous trigonoplasty Intracorporeal FNS Guillonneau et al 2000 [20] Urethrovesical anastomosis Intracorporeal FNS Hubner et al 1994 [22] Nephropexy Staples Kerbl et al 1993 [25] Bladder closure Endo-GIA stapler Kozminski and Partamian 1992 [27] Ileal conduit Intracorporeal bowel stapling; extra-corporeal ureteroenterostomy Lakshmanan et al 2000 [29] Vesico-ureteral re¯ux repair Intracorporeal FNS Lorenzo et al 1997 [31] Appendicovesicostomy Extracorporeal anastomosis McDougall 1996 [34] Bladder neck suspension Intracorporeal FNS; Lapra-Ty Nakada et al 1995 [37] Pyeloplasty Intracorporeal FNS; Lapra-Ty Nezhat et al 1992 [38] Ureteroureterostomy Intracorporeal FNS Ou and Rowbotham 1999 [40] Burch colposuspension Clips & mesh Parra et al 1994 [42] Cystotomy closure Intracorporeal FNS Polascik et al 1995 [43] Burch colposuspension Intracorporeal FNS; Lapra-Ty Rassweiler et al 1999 [47] Urethrovesical anastomosis Intracorporeal FNS Strand et al 1997 [55] Cutaneous ureterovesicostomy Lap-assisted; extracorporeal suturing Urban et al 1993 [59] Nephropexy Intracorporeal FNS Vancaille et al 1991 [60] Bladder neck suspension Intracorporeal FNS Vara-Thorbeck and Sanchez-de-Badajoz 1994 [61] Ileal conduit Extracorporeal ureteroenterostomy…”