THE TAPERED AND REIMPLANTED SMALL-BOWEL AS A VARIATION OF THE MITROFANOFF PROCEDURE - PRELIMINARY-RESULTS

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.