Orthotopic urethral substitution in female patients using the Mitrofanoff principle

Purpose: We present our experience with orthotopic urethral substitution in female patients using the Mitrofanoff principle. Materials and Methods: We performed orthotopic urethral substitution using the Mitrofanoff principle in 18 female patients 1 to 29 years old (mean age 10). The conduit was constructed with appendix in 13 cases, tapered ileum in 4 and fallopian tube in 1. The etiology of incontinence included exstrop hy in 8 patients, neurogenic bladder in 3, urogenital sinus in 3, and bilat eral ectopic meter, ectopic ureterocele, the prune-belly syndrome and post- cystectomy undiversion in 1 each. Results: Mean followup was 29 months (range 9 to 72). A total of 16 patient s achieved continence following a program of clean intermittent catheteriza tion. There were 2 unsuccessful operations. In 1 case the appendix become i schemic and in 1 a vesicoperineal fistula developed. One patient catheteriz es every 2 hours to avoid leakage. Catheterization was temporarily difficul t in 5 patients, of whom 2 had an appendiceal and 3 had a tapered ileal con duit. Two patients with an ileal conduit have had chronic difficult cathete rization. Conclusions: Orthotopic replacement of the urethra using the Mitrofanoff pr inciple is suitable in highly select female patients who need continent div ersion or a catheterizable conduit but who will not accept an abdominal sto ma. It is particularly suited to patients in whom exstrophy reconstruction has failed.