Mitrofanoff procedure: more 40 years later.

Nguyễn Hữu Phùng¹, Nguyễn Tăng Miên², Nguyễn Quang Tập ², Bùi Chín²

         Phan Chau Trinh university

                                                                                                             1: Phan Châu Trinh University

                                                                                                               2: DaNang General Hospital

 Summary

Aim: We review 4 cases of continent urinary diversion  performed based on  Mitrofanoff principle at Da Nang General Hospital to asses  surgical complications and the social adaptation of patients after surgery with an average follow-up of 32 years.

Materials and methods: From 1982 to 2001, at Da Nang General Hospital, 4 cases of continent urinary diversion  were performed  based on Mitrofanoff principle using appendix, on three boys  and one girl, aged 4to 12.

Indications included: loss of  in-war posterior urethral damage of 10 years , bladder  and cloacal extrophy.  The Urinary diversion was created using an isolated ileal loop in the patient of  urethral loss.

The  extrophied bladder in the girl was  anastomosed with an isolated ileal loop.  The urine reservoirs of the two patients were drained continently to the skin  by mucosa- lined extramural tunnels

In the remaining two cases bladders  were enlarged with gastroseromuscular flaps. Appendix as  Mitrofanoff conduit in each case was placed under bladder mucosa .

Results:

There were no deaths during the postoperative period. But the complications rate were frequent. Three patients developed stones ,with two requiring surgical removal  including  one patient who had three recurrences while in  another patient with ileal reservoir small stones were continuously pushed out through Mitrofanoff conduit without requiring any surgery. The two patients with enlarged bladder with gastroseromuscular flaps developed bladder fistulas necessitating reoperations  to remove the flaps and  replace them  with ileal ones  after2 and 4 years .

The patient of urethral loss   experienced  urine reflux for his high pressure ileal pouch of 60 cm of water  The Mitrofanoff conduits became incontinent  in 2 cases, one of which was associated with  stricture and shortened, requiring removal   and replaced with Monti conduits after 4 years and 18 years. All patients now have  functional continent conduits.

Conclusion:

The Mitrofanoff procedure has high complication rate . with each patient experiencing an average of two complications and requiring at least two reoperations during  32 year follow-up

High  pressure reservoir associated with the urine reflux and bladder enlargement with gastroseromuscular flaps increased the incidence of complications.. However, all complications were eventually resolved  and the patients achieved  stable urinary  continence  and succesfully social reintergration.

Key words: Appendix, Mitrofanoff, Bladder augmentation