Appendicovesicostomy and newer alternatives for the Mitrofanoff procedure: Results in the last 100 patients at Riley children's hospital

Mark P. Cain, Anthony J. Casale, Shelly J. King, Richard C. Rink

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Purpose: We present our experience using the various Mitrofanoff techniques to create a continent catheterizable stoma as an adjunct to continent urinary tract reconstruction in children and young adults. Materials and Methods: Between 1990 and 1998 a Mitrofanoff procedure was performed at our institution in 55 male and 45 female patients with a mean age of 10.5 years. The etiology of incontinence was diverse but more than 90% of the patients had neurogenic bladder, the epispadias-exstrophy complex or a cloacal anomaly. Surgery included appendicovesicostomy in 57 cases, a Yang- Monti ileovesicostomy in 21, continent vesicostomy in 21 and formation of a tapered ileal segment as a catheterizable channel in 1. Simultaneously bladder augmentation was performed in 52 patients, bladder neck reconstruction was done in 48 and a Malone antegrade colonic enema stoma was constructed for fecal incontinence in 17. Results: The abdominal stoma is continent in 98 of our 100 patients. Mean followup is 2 years (range 2 months to 8 years) with the longer followup in the appendicovesicostomy group. One patient with stomal incontinence who underwent revision is now dry. Postoperative complications requiring an additional procedure developed in 20 patients, including stomal stenosis in 12. Continent vesicostomy was most prone to stomal problems (6 of 21 patients, 29%). Conclusions: The Mitrofanoff procedure is a reliable technique for creating a continent catheterizable urinary stoma. Appendicovesicostomy continues to be our first option for this procedure, although we have also had good results with the Yang-Monti ileovesicostomy and continent vesicostomy. These newer options have allowed preservation of the appendix for the Malone antegrade colonic enema stoma procedure in patients with urinary and fecal incontinence.

Original languageEnglish (US)
Pages (from-to)1749-1752
Number of pages4
JournalJournal of Urology
Volume162
Issue number5
DOIs
StatePublished - 1999
Externally publishedYes

Fingerprint

Cystostomy
Fecal Incontinence
Enema
Urinary Bladder
Epispadias
Bladder Exstrophy
Neurogenic Urinary Bladder
Urinary Incontinence
Urinary Tract
Young Adult
Pathologic Constriction

Keywords

  • Appendix
  • Bladder
  • Cystostomy
  • Stomas
  • Urinary diversion

ASJC Scopus subject areas

  • Urology

Cite this

Appendicovesicostomy and newer alternatives for the Mitrofanoff procedure : Results in the last 100 patients at Riley children's hospital. / Cain, Mark P.; Casale, Anthony J.; King, Shelly J.; Rink, Richard C.

In: Journal of Urology, Vol. 162, No. 5, 1999, p. 1749-1752.

Research output: Contribution to journalArticle

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abstract = "Purpose: We present our experience using the various Mitrofanoff techniques to create a continent catheterizable stoma as an adjunct to continent urinary tract reconstruction in children and young adults. Materials and Methods: Between 1990 and 1998 a Mitrofanoff procedure was performed at our institution in 55 male and 45 female patients with a mean age of 10.5 years. The etiology of incontinence was diverse but more than 90{\%} of the patients had neurogenic bladder, the epispadias-exstrophy complex or a cloacal anomaly. Surgery included appendicovesicostomy in 57 cases, a Yang- Monti ileovesicostomy in 21, continent vesicostomy in 21 and formation of a tapered ileal segment as a catheterizable channel in 1. Simultaneously bladder augmentation was performed in 52 patients, bladder neck reconstruction was done in 48 and a Malone antegrade colonic enema stoma was constructed for fecal incontinence in 17. Results: The abdominal stoma is continent in 98 of our 100 patients. Mean followup is 2 years (range 2 months to 8 years) with the longer followup in the appendicovesicostomy group. One patient with stomal incontinence who underwent revision is now dry. Postoperative complications requiring an additional procedure developed in 20 patients, including stomal stenosis in 12. Continent vesicostomy was most prone to stomal problems (6 of 21 patients, 29{\%}). Conclusions: The Mitrofanoff procedure is a reliable technique for creating a continent catheterizable urinary stoma. Appendicovesicostomy continues to be our first option for this procedure, although we have also had good results with the Yang-Monti ileovesicostomy and continent vesicostomy. These newer options have allowed preservation of the appendix for the Malone antegrade colonic enema stoma procedure in patients with urinary and fecal incontinence.",
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