OUTCOME ANALYSIS OF MITROFANOFF PRINCIPLE APPLICATIONS USING APPENDIXAND URETER TO UMBILICAL AND LOWER QUADRANT STOMAL SITES

Purpose: We compared the indications for and results of application of the Mitrofanoff principle using appendix and ureter to umbilical and lower quadrant stomal sites. Material and Methods: We created continen t catheterizable conduits in 60 patients 3 days to 20 years old (mean age 8.8 years), The primary: indication was refractory urinary inconti nence associated with bladder or cloacal exstrophy, or anomalies in 31 cases. We constructed 38 umbilical (all appendix) and 22 lower quadra nt (10 appendix and 12 ureter) stomas. Mean followup was 3 years. Resu lts: We preferred the umbilicus as a stomal site for its cosmetic valu e. The most common indication for a lower quadrant stomal site was pre servation of the retroperitoneal course of the ureter. The stomal sten osis rate was 13 and 4% in patients with umbilical and lower quadrant stomas, respectively. We preferred the appendix as a conduit due to av ailability. Indications for the ureter as a catheterizable conduit wer e absence of an adequate appendix or presence of a healthy ureter afte r nephrectomy, The appendiceal and ureteral conduits were catheterizab le in 94 and 84% of patients, respectively, and continence was achieve d in 97%. Conclusions: In a complex group of patients with incontinenc e application of the Mitrofanoff principle yielded good results for ei ther combination of stomal site or catheterizable conduit. Appendicove sicostomy to the umbilicus remains our preferred procedure.