Appendicovesicostomy and newer alternatives for the mitrofanoff procedure:Results in the last 100 patients at Riley Children's Hospital

Purpose: We present our experience using the various Mitrofanoff techniques to create a continent catheterizable stoma as an adjunct to continent urin ary tract reconstruction in children and young adults. Materials and Methods: Between 1990 and 1998 a Mitrofanoff procedure was pe rformed at our institution in 55 male and 45 female patients with a mean ag e of 10.5 years. The etiology of incontinence was diverse but more than 90% of the patients had neurogenic bladder, the epispadias-exstrophy complex o r a cloacal anomaly. Surgery included appendicovesicostomy in 57 cases, a Y ang-Monti ileovesicostomy in 21, continent ileovesicostomy in 21 and format ion of a tapered ileal segment as a catheterizable channel in 1. Simultaneo usly bladder augmentation was performed in 52 patients, bladder neck recons truction was done in 48 and a Malone antegrade colonic enema stoma was cons tructed for fecal incontinence in 17. Results: The abdominal stoma is continent in 98 of our 100 patients. Mean f ollowup is 2 years (range 2 months to 8 years) with the longer followup in the appendicovesicostomy group. One patient with stomal incontinence who un derwent revision is now dry. Postoperative complications requiring am addit ional procedure developed in 20 patients, including stomal stenosis in 12. Continent vesicostomy was most prone to stomal problems (6 of 21 patients, 29%). Conclusions: The Mitrofanoff procedure is a reliable technique for creating a continent catheterizable urinary stoma. Appendicovesicostomy continues t o be our first option for this procedure, although we have also had good re sults with the Yang-Monti ileovesicostomy and continent vesicostomy. These newer options have allowed preservation of the appendix for the Malone ante grade colonic enema stoma procedure in patients with urinary and fecal inco ntinence.