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Appendicovesicostomy: the mitrofanoff procedure-a 15-year perspective
C F Harris1, C S Cooper, J C Hutcheson
1Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Purpose:
Appendicovesicostomy was introduced in the United States in 1982 at our hospital. It has become the most popular alternate continence channel for catheterization. We reviewed the experience of 1 surgeon with appendicovesicostomy during a 15-year period.
Materials And Methods:
We retrospectively reviewed the operative reports and clinical records of 50 consecutive patients in whom appendicovesicostomy was performed by 1 surgeon between 1982 and 1998. The underlying diagnosis was myelomeningocele in 31 cases, bladder exstrophy in 6, the prune-belly syndrome in 2, posterior urethral valves in 2 and other disorders in 10. Mean patient age at surgery was 13.1 years (range 4 months to 25 years) and mean followup was 4.3 years (range 3 months to 16.3 years).
Results:
Of the 50 patients 96% continue to catheterize the appendicovesicostomy. Stomal stenosis developed in 5 cases (10%) and other complications included stricture and appendiceal perforation in 2 each. Eight patients (16%) required appendicovesicostomy revision at a median of 7.3 months (range 1 month to 5.8 years) after the initial procedure. Median time to revision for stomal stenosis was 13 months (range 1 month to 5.8 years). Appendicovesicostomy continence was achieved in 49 patients (98%).
Conclusions:
Our series demonstrates the successful long-term outcome and durability of appendicovesicostomy in children. Careful adherence to technique at initial surgery helps ensure a high long-term success rate.
Insights
Appendicovesicostomy is a durable and successful method for urinary continence in children, with 98% achieving continence. Careful surgical technique is key to its long-term effectiveness.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Continence Management
Background:
- Appendicovesicostomy, introduced in 1982, is a popular method for creating a continent urinary diversion.
- This review examines the long-term outcomes of appendicovesicostomy performed by a single surgeon.
Purpose of the Study:
- To evaluate the long-term success and durability of appendicovesicostomy in a pediatric population.
- To assess complication rates and the need for revision surgery.
Main Methods:
- Retrospective review of 50 consecutive appendicovesicostomy cases performed between 1982 and 1998.
- Analysis of operative reports and clinical records, with a mean follow-up of 4.3 years.
Main Results:
- 96% of patients successfully self-catheterize the appendicovesicostomy.
- High continence rate of 98% was achieved.
- Complications included stomal stenosis (10%) and required revision in 16% of cases.
Conclusions:
- Appendicovesicostomy demonstrates successful long-term outcomes and durability in children.
- Meticulous surgical technique is crucial for achieving high long-term success rates.