Detrusorectomy with Mitrofanoff stoma

The clinical and social benefits derived from bladder augmentation are well known. Most procedures involve the implantation of gastric or intestinal segments into the bladder. These have problems of the acid-haematuria syndrome, mucous production, urinary infection, stone formation and metabolic disturbances. Lang and colleagues presented their experiences in 1994 with detrusorectomy alone as an alternative procedure. We have performed detrusorectomy with Mitrofanoff stoma on 9 patients, protecting the denuded bladder mucosa with omentum. This represents 50% of the bladder reconstructions managed over an 18-month period. Follow-up urodynamics studies have demonstrated a compliant low-pressure system of good capacity in all but one case. Apart from this failure, all the rest are continent. One boy suffered a ruptured bladder due to rough play and another suffered excruciating bladder pain on drainage. He was managed by the instillation of bupivicaine (4 mg/kg) twice daily. Successful management of cases depends on intensive support of the outreach nursing service.