THE ROLE OF URETER IN THE CREATION OF MITROFANOFF CHANNELS IN CHILDREN

Purpose: Since 1980 numerous variations of the Mitrofanoff principle h ave been described. We report on 22 children in whom a ureteral Mitrof anoff channel was created. Materials and Methods: Between 1986 and 199 5 a ureteral Mitrofanoff channel was constructed as a catheterizable c onduit in 22 children 2 to 15 years old (average age 6.5) with various abnormalities of the lower urinary tract, mainly exstrophy and neurog enic bladder. Indications included unavailability or unsuitability of the appendix, preference for appendix as a catheterizable colonic stom a for antegrade washouts or concomitant removal of a nonfunctioning ki dney, leaving the ureter available for use. Surgical technique was bas ed on the principles of appendicovesicostomy and in 9 cases the ureter al Mitrofanoff channel was reimplanted. Results: Followup ranged from 1 to 72 months (average 30.5). Complications included stenosis of the conduit that caused difficult catheterization in 3 patients, necessita ting dilation or minor revision in 2 and complete replacement by appen dix in 1. Urinary leakage from the Mitrofanoff channel in 5 patients w as treated with polydimethylsiloxane injection or oxybutinin. In 1 pat ient the channel was reimplanted, since the catheter struck the bladde r neck during catheterization and caused severe pain. Conclusions: Res ults of the ureteral Mitrofanoff channel seem somewhat less satisfacto ry than those of appendicovesicostomy but they remain acceptable and e ven comparable, strongly supporting its use in certain circumstances.