The Yang-Monti ileovesicostomy: a problematic channel?

Objective To compare the differences in the quality of Mitrofanoff channels created using appendix and re-tubularized small bowel (the Yang-Monti ileo vesicostomy). Patients and methods The case-notes were reviewed retrospectively for all p atients who underwent a Mitrofanoff procedure using either appendix or smal l bowel, over a 5-year period from June 1994 to July 1999. Results In all, 92 patients underwent 94 Mitrofanoff procedures; the append ix was used in 69 and small bowel in 25. The underlying diagnoses were exst rophy-epispadias complex (38), neuropathic bladder (21), anorectal malforma tions and cloacal anomalies (15), posterior urethral valves (nine) and misc ellaneous (nine), The mean (range) age at operation was 9.2 (1.1-18.3) year s. The mean (range) follow-up for the appendix group was 37(6.7-65)months a nd for the Monti group 25(6-66) months. Catheterization problems occurred i n 18 (27%) patients from the appendix group; two needed an adjustment of te chnique, six dilatation and 10 revision. Stomal stenosis occurred in 10 (15 %) patients, bladder level stenosis in four (6%) and conduit necrosis in tw o, Catheterization problems were reported in 15 (60%) patients from the Mon ti group; ti ire needed revision, three dilatation and seven are being mana ged conservatively. The incidences of stomal stenosis (four, 16%) and bladd er level stenosis (two, 8%) were comparable with the appendix group, In add ition, two patients had distal channel (sub-stomal) stenosis and two had mi d-channel stenosis. The problem unique to the Yang-Monti channel was a pouc h-like dilatation in seven patients (28%), all of whom presented with cathe terization problems; five are being managed conservatively and two have nee ded pouch resection. Stomal prolapse occurred in five (7%) patients in the appendix group, but in none of the Monti group. Conclusions The appendix is the conduit of choice for a Mitrofanoff procedu re. Re-tubularized small bowel conduits have a considerably higher incidenc e of catheterization problems. Anatomical factors may contribute to the uni que incidence of pouch formation.