RESULTS OF THE MITROFANOFF PROCEDURE IN URINARY-TRACT RECONSTRUCTION IN CHILDREN

Objectives To evaluate the success and long-term complications associa ted with the use of continent catheterizable conduits based on the Mit rofanoff principle in children. Patients and methods The records of 43 patients (21 female and 22 male) who underwent the construction of a continent catheterizable stoma based on the Mitrofanoff principle betw een 1987 and 1996 were reviewed retrospectively. The mean age at surge ry was 10 years (range 3-21) and the mean follow-up was 3 years (range 0.5-6.5), Twenty-eight of the 43 children underwent augmentation cyst oplasty in conjunction with the Mitrofanoff procedure, using ileum in 17, sigmoid in seven, caecum in two and stomach in one; detrusormyecto my was performed in one child. Fifteen patients had only a continent c atheterizable stoma formed. The most common type of conduit was append icovesicostomy (36 of 43 children); other conduits were constructed wi th meter (four), tapered ileum (two) and fallopian tube (one). Results Stomal continence was achieved in 42 of 43 patients (98%). The most c ommon late complication was difficulty in catheterization, which occur red in 14 patients (32%). Stomal prolapse requiring revision occurred in one patient (2%). Conduit dilatation was initially attempted iii al l patients with difficult catheterization, although it failed in 11 wh o then required surgical revision. Therefore, the overall revision rat e was 28% (12 of 43), The site of stomal placement (umbilical or abdom inal) did not significantly influence the risk of difficulty with cath eterization. Conclusion The Mitrofanoff procedure can simplify cathete rization in children who are dependent upon intermittent catheterizati on. The vermiform appendix appears to be the best source for construct ing the conduit. While stomal continence is excellent, conduit stenosi s remains a frequent complication regardless of stomal location.