APPLICATION OF THE MITROFANOFF PRINCIPLE IN CHILDREN WITH SEVERE IMPAIRMENT OF BLADDER FUNCTION

Treatment of children with severe impairment of bladder function requi res a large-volume, low-pressure reservoir combined with a continent, easily catheterizable valve. The Mitrofanoff principle (MP) appears to meet these requirements. Between 1986 and 1993, the MP was applied in 15 children (4 girls) aged 4 to 14 years. The primary diagnosis was b ladder exstrophy in 8 (2 girls), neuropathic bladder in 3 (2 girls), u rethral valves in 2, and rhabdomyosarcoma (RMS) in 2. In 10 patients b ladder augmentation with an intestinal patch was performed in addition to a Mitrofanoff procedure. in 5 a neobladder and continent appendico stomy were made. One boy with RMS died of distant metastases with a we ll-functioning appendicostomy and adequate renal function. At 2 to 9 y ears follow-up of the other 14 patients, 12 have a good result defined as: (1) adequate reservoir capacity; (2) continence; (3) normal renal function; and (4) no hydronephrosis. In 1 exstrophy patient with pree xisting impairment of renal function, further deterioration necessitat ed frequent catheterization and additional medical treatment. In 1 boy with fulgurated urethral valves, spontaneous micturition became subse quently possible, allowing closure of his appendicovesicostomy. Compli cations occurred in 10 patients, necessitating reintervention in 7. Th e MP in combination with the creation of an adequate reservoir gives g ood results in children with severe impairment of bladder function. Ca reful attention should be given to patient education regarding emptyin g of the reservoir Long-term follow-up of renal function is mandatory.