THE MITROFANOFF PRINCIPLE FOR URETHRAL FAILURE

Objective To assess the outcome of surgery for urethral failure. Patie nts and methods Patients undergoing lower urinary tract reconstruction are recorded prospectively by protocol. Thirty-four are presented who se urethra had failed as a conduit; in 23 the urethra was incontinent and in 11 it was spastic causing chronic retention. The incontinent pa tients had failed a variety of reconstructions, in five including inse rtion of an artificial sphincter. Those with chronic retention were un able to self-catheterize the urethra. Results A continent supra-pubic diversion using the Mitrofanoff principle was performed. In two patien ts a new technique was used in which a detrusor tube formed the contin ent conduit. Ninety-four per cent of patients were continent. Two pati ents voided to completion, the remainder emptied by self-catheterizati on. Five minor revisions were required to allow easy catheterization. There was one death. The complication rate was 17%. Conclusion This ty pe of reconstruction is preferable to the formation of an ileal condui t in this difficult group of patients.