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The Mitrofanoff procedure in paediatric urinary tract reconstruction
1Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Summary
The Mitrofanoff principle provides a reliable continent catheterizable stoma for children needing urinary tract reconstruction and clean intermittent catheterization (CIC). The appendix is ideal, with the ureter as a good alternative.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Continent Diversion
Background:
- Urinary tract reconstruction is crucial for pediatric urological conditions.
- Clean intermittent catheterization (CIC) is a common management strategy.
- Continent catheterizable abdominal stomas are created using various tubular structures.
Purpose of the Study:
- To evaluate the efficacy and reliability of the Mitrofanoff principle for continent urinary diversion in children.
- To assess the suitability of different tissues (appendix, ureter, colon) for creating catheterizable stomas.
Main Methods:
- A cohort of 23 children underwent urinary tract reconstruction with continent diversion (Mitrofanoff principle) between 1991-1996.
- The appendix was used in 14 patients, the ureter in seven, and isolated colon segments or detrusor tubes in two.
- Surgical complexity varied among the reconstructive procedures.
Main Results:
- Continent stomas were achieved in most patients (12 appendix, 6 ureteric, 1 colonic).
- Patients successfully performed CIC independently, with good comfort.
- Complications included stomal stenosis (colonic tube), incontinence (one appendix), and tube division (one appendix); one detrusor tube strictured.
Conclusions:
- Continent abdominal stomas via the Mitrofanoff principle are reliable and well-tolerated in pediatric urinary tract reconstruction requiring CIC.
- The appendix is a highly suitable conduit, with the ureter as a viable alternative.
- Alternative techniques should be considered when appendix or ureter are unavailable.