TRANSVERSE RETUBULARIZED ILEUM - EARLY CLINICAL-EXPERIENCE WITH A NEW2ND LINE MITROFANOFF TUBE

Purpose: Transverse retubularization of small ileal segments has been described as a new time and labor saving variation of the Mitrofanoff principle in a dog model with good functional results. We report our i nitial clinical experience with this technique. Materials and Methods: From May 1996 through January 1997 a new technique of channel formati on for intermittent catheterization was applied in 9 children (1 to 16 years old) and 7 adults (18 to 56) with various abnormalities of the lower urinary tract. The new method was used in primary reconstruction of the lower urinary tract and in revision procedures. An ileal segme nt 2 cm. long was excised. The bowel wall was opened longitudinally ab out 1 cm. from the mesentery. The resulting rectangle was retubularize d over a 14F catheter in transverse direction. The longer portion of t he tube was implanted submucosally into the native bladder, the augmen ted bladder or an intestinal reservoir. The shorter portion was used t o form the stoma. In 4 patients we created a double tube. Results: Of the patients 13 (81%) are completely continent day and night with easy catheterization postoperatively. In 2 cases of tunnel failure continu ous leakage required reimplantation of the intact ileal tube to achiev e continence. Minor leakage with bladder fullness in an 11-year-old bo y could be obviated by adjusting the interval of catheterization. Conc lusions: With the advantage of constant availability, minimal loss of bowel, relative simplicity (no mesentery interfering with implantation , high tube mobility), minimized risk of stone formation (no staples), reliable continence (no leak point) and easy catheterization (longitu dinal folds), this straightforward technique is an excellent second ch oice use of the Mitrofanoff principle.