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Appendicovesicostomy (and variations) in bladder reconstruction
1Division of Urology, Children's Hospital of Philadelphia, Pennsylvania.
The Journal of Urology
|March 1, 1993
Summary
The Mitrofanoff principle, using appendix or bowel segments for bladder reconstruction, offers reliable catheter access and continence in pediatric cases. However, long-term follow-up reveals a significant risk of stone formation.
Area of Science:
- Pediatric Surgery
- Urology
- Reconstructive Surgery
Background:
- Bladder reconstruction in children often requires alternative catheter access due to urethral limitations.
- The Mitrofanoff principle offers a solution by creating a continent channel for catheterization.
Purpose of the Study:
- To evaluate the long-term outcomes of bladder reconstruction using the Mitrofanoff principle in pediatric patients.
- To assess continence, catheterization success, and complications associated with this technique.
Main Methods:
- Application of the Mitrofanoff principle in 41 pediatric bladder reconstructions since 1982.
- Utilized isolated appendix, tapered ileum, or ureter segments for continent channels.
- Patient diagnoses included bladder exstrophy and myelomeningocele.
Main Results:
- Achieved 100% continence and 93% uncomplicated catheterization rates.
- Observed a 32% incidence of stone formation, linked to mucus and bacteriuria.
- Complications included stomal revisions, bowel obstructions, and stone removals; 2 deaths occurred.
Conclusions:
- The Mitrofanoff principle provides satisfactory continence and catheterization in pediatric bladder reconstruction.
- Long-term follow-up highlights stone formation as a significant complication requiring management.
- Further research into mitigating stone formation is warranted.