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Application of the Mitrofanoff principle in children with severe impairment of bladder function
H A Heij1, S Ekkelkamp, C G Moorman-Voestermans
1Kinderchirurgisch Centrum Amsterdam, Emma Kinderziekenhuis/Kinder AMC and Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands.
Insights
The Mitrofanoff principle (MP) offers a continent, catheterizable valve for children with severe bladder dysfunction. This surgical technique, combined with reservoir creation, shows good results in 12 of 14 patients, emphasizing long-term renal function monitoring.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Bladder Reconstruction
Background:
- Severe bladder dysfunction in children necessitates specialized urinary diversion.
- The Mitrofanoff principle (MP) offers a continent, low-pressure, large-volume reservoir with an easily catheterizable valve.
Purpose of the Study:
- To evaluate the efficacy and outcomes of the Mitrofanoff principle in pediatric patients with severe bladder dysfunction.
- To assess the long-term results, including continence, renal function, and complications.
Main Methods:
- Retrospective analysis of 15 children (aged 4-14) who underwent the Mitrofanoff procedure between 1986 and 1993.
- Procedures included bladder augmentation or neobladder creation alongside continent appendicostomy.
- Follow-up ranged from 2 to 9 years.
Main Results:
- 12 of 14 patients achieved good outcomes: adequate reservoir capacity, continence, normal renal function, and no hydronephrosis.
- One patient with bladder exstrophy experienced renal function deterioration.
- One patient with urethral valves achieved spontaneous micturition, allowing stoma closure.
Conclusions:
- The Mitrofanoff principle, when combined with adequate reservoir creation, yields favorable results for children with severe bladder dysfunction.
- Patient education on reservoir emptying and long-term renal function monitoring are crucial for optimal outcomes.
- Complications occurred in 10 patients, with 7 requiring reintervention.
Abstract:
Treatment of children with severe impairment of bladder function requires a large-volume, low-pressure reservoir combined with a continent, easily catheterizable valve. The Mitrofanoff principle (MP) appears to meet these requirements. Between 1986 and 1993, the MP was applied in 15 children (4 girls) aged 4 to 14 years. The primary diagnosis was bladder exstrophy in 8 (2 girls), neuropathic bladder in 3 (2 girls), urethral valves in 2, and rhabdomyosarcoma (RMS) in 2. In 10 patients bladder augmentation with an intestinal patch was performed in addition to a Mitrofanoff procedure; in 5 a neobladder and continent appendicostomy were made. One boy with RMS died of distant metastases with a well-functioning appendicostomy and adequate renal function. At 2 to 9 years follow-up of the other 14 patients, 12 have a good result defined as: (1) adequate reservoir capacity; (2) continence; (3) normal renal function; and (4) no hydronephrosis. In 1 exstrophy patient with pre-existing impairment of renal function, further deterioration necessitated frequent catheterization and additional medical treatment. In 1 boy with fulgurated urethral valves, spontaneous micturition became subsequently possible, allowing closure of his appendicovesicostomy. Complications occurred in 10 patients, necessitating reintervention in 7. The MP in combination with the creation of an adequate reservoir gives good results in children with severe impairment of bladder function. Careful attention should be given to patient education regarding emptying of the reservoir. Long-term follow-up of renal function is mandatory.