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The Yang-Monti ileovesicostomy: a problematic channel?
B Narayanaswamy1, D T Wilcox, P M Cuckow
1Department of Paediatric Urology, Great Ormond Street Hospital, London, UK.
Objective:
To compare the differences in the quality of Mitrofanoff channels created using appendix and re-tubularized small bowel (the Yang-Monti ileovesicostomy). Patients and methods The case-notes were reviewed retrospectively for all patients who underwent a Mitrofanoff procedure using either appendix or small bowel, over a 5-year period from June 1994 to July 1999.
Results:
In all, 92 patients underwent 94 Mitrofanoff procedures; the appendix was used in 69 and small bowel in 25. The underlying diagnoses were exstrophy-epispadias complex (38), neuropathic bladder (21), anorectal malformations and cloacal anomalies (15), posterior urethral valves (nine) and miscellaneous (nine). The mean (range) age at operation was 9.2 (1.1-18.3) years. The mean (range) follow-up for the appendix group was 37 (6.7-65) months and for the Monti group 25 (6-66) months. Catheterization problems occurred in 18 (27%) patients from the appendix group; two needed an adjustment of technique, six dilatation and 10 revision. Stomal stenosis occurred in 10 (15%) patients, bladder level stenosis in four (6%) and conduit necrosis in two. Catheterization problems were reported in 15 (60%) patients from the Monti group; five needed revision, three dilatation and seven are being managed conservatively. The incidences of stomal stenosis (four, 16%) and bladder level stenosis (two, 8%) were comparable with the appendix group. In addition, two patients had distal channel (sub-stomal) stenosis and two had mid-channel stenosis. The problem unique to the Yang-Monti channel was a pouch-like dilatation in seven patients (28%), all of whom presented with catheterization problems; five are being managed conservatively and two have needed pouch resection. Stomal prolapse occurred in five (7%) patients in the appendix group, but in none of the Monti group.
Conclusions:
The appendix is the conduit of choice for a Mitrofanoff procedure. Re-tubularized small bowel conduits have a considerably higher incidence of catheterization problems. Anatomical factors may contribute to the unique incidence of pouch formation.
Insights
The appendix is the preferred material for creating Mitrofanoff channels, offering fewer catheterization issues compared to small bowel segments. Small bowel conduits show a higher rate of complications, including pouch formation.
Area of Science:
- Urology
- Pediatric Surgery
Background:
- The Mitrofanoff procedure creates a channel for bladder management.
- Choosing the optimal conduit material is crucial for long-term success.
Purpose of the Study:
- To compare the quality and complication rates of Mitrofanoff channels constructed from appendix versus re-tubularized small bowel (Yang-Monti ileovesicostomy).
Main Methods:
- Retrospective review of 92 patients undergoing 94 Mitrofanoff procedures over a 5-year period.
- Analysis of data including patient diagnoses, age, follow-up duration, and complication types.
Main Results:
- Appendix conduits (69 cases) had 27% catheterization problems, 15% stomal stenosis, and 7% stomal prolapse.
- Yang-Monti ileovesicostomy conduits (25 cases) had 60% catheterization problems, comparable stenosis rates, and a unique 28% incidence of pouch formation.
- No stomal prolapse was observed in the Yang-Monti group.
Conclusions:
- Appendix is the conduit of choice for Mitrofanoff procedures due to lower complication rates.
- Re-tubularized small bowel conduits present a significantly higher incidence of catheterization problems.
- Anatomical factors specific to the Yang-Monti channel may lead to pouch formation.