Te. Figueroa et al., THE TAPERED AND REIMPLANTED SMALL-BOWEL AS A VARIATION OF THE MITROFANOFF PROCEDURE - PRELIMINARY-RESULTS, The Journal of urology, 152(1), 1994, pp. 73-75
Ten patients with a urethra that could not be catheterized and with ab
sent appendixes underwent neobladder construction using an ileal segme
nt fashioned to serve as the anti-incontinence mechanism. The latter w
as tapered and reimplanted following the guidelines of the Mitrofanoff
procedure. Urinary reservoirs were constructed from detubularized seg
ments of right colon, sigmoid colon and composite gastro-ileal combina
tions. Followup ranged from 9 to 21 months (mean 14.5). All patients p
resently catheterize the reservoir satisfactorily and are free of urin
ary leakage. Three patients (30%) experienced initial catheterization
difficulties: 2 required endoscopic procedures and insertion of a sten
t, and 1 with stomal stenosis was successfully treated with a Y-V stom
a plasty. One patient (10%) required a repeat ileal segment reimplanta
tion due to urinary incontinence. The higher reoperation rate and the
increased surgical complexity of this procedure compared with reconstr
uctions using the ileocecal valve as part of the anti-incontinence mec
hanism make this operation a less attractive alternative in the creati
on of a continent urinary reservoir. However, with comprehension of th
e need for careful and detailed surgical technique in its creation, th
e tapered and reimplanted ileal segment is a successful choice as an a
lternative for the creation of an abdominal wall stoma when the append
ix is unavailable.