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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.
Insights
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.
Background:
Urinary tract reconstruction is required in many congenital and some acquired urological conditions in childhood. The majority are managed by clean intermittent catheterization (CIC), for which purpose the appendix or other tubular structure may be used to provide a continent catheterizable abdominal stoma.
Methods:
Between 1991 and 1996, 23 children underwent urinary tract reconstruction of varying complexity together with a continent diversion according to the Mitrofanoff principle. The appendix was used in 14 patients and the ureter in seven. Two patients had previously had an appendicectomy and the ureters were not suitable. One had a catheterizable channel made from an isolated segment of colon and the other had a detrusor tube constructed.
Results:
Twelve patients with an appendix conduit, six with a ureteric conduit, and one with a colonic tube are continent, although the latter has had some problems with stomal stenosis. All manage CIC with comfort, the older children doing the procedure themselves. One appendix conduit has stomal incontinence and another was inadvertently divided during renal transplantation. The detrusor tube strictured and was removed.
Conclusions:
A continent abdominal stoma using the Mitrofanoff principle gives reliable results in children and is well tolerated. It should be considered in the management of children undergoing urinary tract reconstruction when CIC is necessary. The appendix is eminently suitable for this purpose but the ureter provides a satisfactory alternative in selected cases. When neither is available, alternative techniques for constructing a catheterizable continent channel may be considered.