Refluxing megaureter for the Mitrofanoff channel using continent extravesical detrusor tunneling procedure

We present a variation on the continent procedure using the refluxing megaureter for the Mitrofanoff channel, and its results.

The Mitrofanoff procedure using the refluxing megaureter was performed in 35 patients (valve bladder syndrome 15, neurogenic bladder 10, non-neurogenic bladder 10) between 1995 and 2001. Mean patient age was 5.9 years. In 5 patients the distal segment of the megaureter was used after nephrectomy, and in 30 patients the proximal segment of the megaureter was simultaneously reimplanted unilaterally. The distal segment of the megaureter was inserted under the detrusor close to the native hiatus, pulled through the tunnel between the unresected detrusor and the mucosa, and subsequently brought to the abdominal wall. The ureterovesical junction was left intact.

In all of our patients we obtained sufficient length and good vascularization of both ureteral segments. Satisfactory tunnel length was achieved in 29 patients. In 6 cases the tunnel was elongated by dissection of the detrusor. Median followup was 37 months. Three patients had development of stenosis at the stoma level, which resolved with minimal revision at the ureter-skin level. Minimal leakage occurred in 3 patients, all of whom were successfully treated with anticholinergics. On routine followup no patient had signs of reflux recurrence in the reimplanted ureter.

The results of our variant procedure expand the number of patients who may benefit from use of the ureter for the Mitrofanoff channel.