Catheterisable continent urinary diversion (Mitrofanoff principle) - Clinical experience and psychological aspects

48 Mitrofanoff principles (MTR) were performed on 46 patients (male: female ratio, 30:16) with a mean age of 9.1 years (range 2.5 to 24 years). The pr imary diagnoses were neurogenic bladder in 11, infravesical obstruction in 7 and bladder exstrophy-epispadias complex in 28 patients. The most common type of conduit was appendix (38 cases); other conduits were constructed fr om the ileum (seven) and lleocaecum (one). In two cases with bladder substi tution the uterine tube and tubularised bladder stump were used as perineal MTR. 33 of the 46 children underwent augmentation cystoplasty in conjuncti on with the MTR procedure. The Malone procedure for antegrade colonic enema (ACE) was performed at the same stage with MTR in eight cases. To achieve continence, bladder neck reconstruction was performed in 32 patients and th e bladder neck was closed in four patients during the same operation and MT R procedure. The mean follow-up period was 28.7 months (range one month to 57 months). To assess the psychological aspects of the MTR procedure, the R osenberg Self-Esteem Scales were completed by 12 children older than eight years of age. Nine patients had problems with the MTR (19.5%). Three append iceal MTR had strictures at the skin level, 2 of which needed minor surgica l revisions. A mucocele formation at the skin level of an appendix was remo ved successfully. We did not observe any complaints among the other appendi ceal conduits. All the tapered ileum conduits were difficult to catheterise , and 1 of them had a leakage from the stoma. None of the three transversel y tubularised ileum MTRs had problems with catheterisation or leakage. A st ricture of the conduit from the uterine tube was observed. 36 of the 42 pat ients are now continent, giving a ratio of 86%. The results of the Rosenber g Self-Esteem Scales revealed that there was an increase in the percentage of patients with high self-esteem, and a decrease in depressive feelings af ter the MTR procedure. We conclude that the MTR procedure provides excellen t continence, offers good prospects of a socially acceptable life with incr eased self-esteem, and the appendix seems to be the ideal organ for contine nt urinary diversion, with the transverse tubularised ileal tube as a secon d choice.