Continent catheterizable conduit for urinary diversion in children: Applicability and acceptability (original) (raw)
Related papers
Journal of Pediatric Urology, 2010
We evaluated the role of clean intermittent self-catheterization through a continent catheterizable Mitrofanoff channel in an augmented bladder in children with bladder dysfunction and outlet obstruction. Materials and Methods: We retrospectively analyzed the records of 82 patients treated at a public sector hospital with pediatric urology services in a developing country. Patients came from all provinces of the country with diverse ethnic, cultural, linguistic, socioeconomic and educational backgrounds. Results: Mean Ϯ SD patient age was 9.07 Ϯ 3.38 years (range 2.5 to 15) with a male-to-female ratio 2.5:1.0. The main congenital and acquired abnormalities were posterior urethral valves in 29% of patients, neuropathic bladder in 22%, nonneurogenic neurogenic bladder in 17%, exstrophy plus epispadias in 10% and urethral stricture in 7%. Augmentation cystoplasty was performed using various bowel segments. The Mitrofanoff channel was made using appendix in 70 cases and by the spiral Monti method in 12. A stoma was created in the right iliac fossa using VQZ plasty in 72 patients and an umbilical stoma was created in 10. Complications included bladder calculus in 3 patients, stomal stenosis in 2, subacute intestinal obstruction in 4 and acute intestinal obstruction in 1. Compliance was observed in greater than 90% of the patients at a mean followup of 860 days. Conclusions: In a developing country setting with a low socioeconomic and educational level it is possible to successfully perform augmentation cystoplasty with clean intermittent self-catheterization through a continent catheterizable channel in children with bladder dysfunction and outlet obstruction. The active role of pediatric urologists in the care, teaching and counseling together with free care to all are the reasons for acceptance and compliance.
Journal of Urology, 2008
We evaluated the role of clean intermittent self-catheterization through a continent catheterizable Mitrofanoff channel in an augmented bladder in children with bladder dysfunction and outlet obstruction. Materials and Methods: We retrospectively analyzed the records of 82 patients treated at a public sector hospital with pediatric urology services in a developing country. Patients came from all provinces of the country with diverse ethnic, cultural, linguistic, socioeconomic and educational backgrounds. Results: Mean Ϯ SD patient age was 9.07 Ϯ 3.38 years (range 2.5 to 15) with a male-to-female ratio 2.5:1.0. The main congenital and acquired abnormalities were posterior urethral valves in 29% of patients, neuropathic bladder in 22%, nonneurogenic neurogenic bladder in 17%, exstrophy plus epispadias in 10% and urethral stricture in 7%. Augmentation cystoplasty was performed using various bowel segments. The Mitrofanoff channel was made using appendix in 70 cases and by the spiral Monti method in 12. A stoma was created in the right iliac fossa using VQZ plasty in 72 patients and an umbilical stoma was created in 10. Complications included bladder calculus in 3 patients, stomal stenosis in 2, subacute intestinal obstruction in 4 and acute intestinal obstruction in 1. Compliance was observed in greater than 90% of the patients at a mean followup of 860 days. Conclusions: In a developing country setting with a low socioeconomic and educational level it is possible to successfully perform augmentation cystoplasty with clean intermittent self-catheterization through a continent catheterizable channel in children with bladder dysfunction and outlet obstruction. The active role of pediatric urologists in the care, teaching and counseling together with free care to all are the reasons for acceptance and compliance.
The continent, catheterizable abdominal conduit in adult urological practice
BJU International, 2008
To report a large, single-centre experience with a continent, catheterizable abdominal conduit in adult patients. We retrospectively reviewed the case notes of all 65 patients who had surgery to create a continent catheterizable conduit based on the Mitrofanoff principle. Operations were carried out over a 13-year period. Data on surgical procedure, complications and final outcome were collected and analysed. The mean age of the patients was 38.4 years and mean follow-up interval was 75.2 months. Patients with neuropathic lower urinary tracts accounted for the largest single indication for reconstruction (36 patients). The appendix was the conduit of choice and was available and suitable for use in 37 patients. There were 57 patients who continued to use their native bladder or had undergone an augmentation or substitution cystoplasty; 24.5% of these 57 individuals had also undergone closure of the bladder neck or urethra. There were postoperative complications requiring laparotomy in five (8%) patients. In all, 30 patients (46%) had catheterization problems, but most of these were easy to treat. Five patients (8%) had an incontinent conduit which was a more difficult problem to deal with. Two patients have died of unrelated cause and five patients have been converted to an ileal conduit. In all, 58 patients (92%) now have a Mitrofanoff conduit, of which 97% are catheterizable and 95% are continent. Continent urinary diversion, based on the Mitrofanoff principle, has similar outcomes in adult urological practice to those described in published paediatric case series. There is good evidence to suggest that Mitrofanoff conduits are durable. However, patients should be aware of complications and the need for long-term follow-up.
The Journal of Urology, 2005
Purpose: Clean intermittent catheterization (CIC) has proven successful for bladder emptying in children without genital sensation with success rates of 94% to 100% in select groups. A subset of the pediatric population requires CIC for bladder dysfunction, yet has normal genital sensation. This study was designed to assess our experience with CIC in genitally sensate children and the health related (HR) quality of life (QOL) for them and their families.
Neurourology and urodynamics, 2018
To compare the impact of the different routes for clean intermittent catheterization on the quality of life of children with lower urinary tract dysfunction. In this cross-sectional study, all children and adolescents under treatment in our clinic from August 2011 to May 2012 who were on CIC for bladder dysfunction were included. To evaluate the technical difficulty and the discomfort associated with the procedure we used a standard visual analog scale. Quality of life was measured using the Pediatric Quality of Life Inventory Version 4.0. A total of 70 children including 38 (54.3%) boys and 32 (45.7%) girls with a mean age of 11.8 ± 3.6 years (range 5 to 18 years) were evaluated. The mean daily number of catheterizations was 4.2 ± 1.1. CIC was performed through the urethra in 51 (72.9%) subjects and a stoma in 19 (27.1%). A 45 (64.3%) were assisted by a caregiver to perform a catheterization. No differences in both difficulty and discomfort for performing CIC were observed between ...
International braz j urol, 2020
Purpose: Continent urinary diversion (CUD) with the Mitrofanoff principle stands as an alternative to urethral catheterization by a route other than the urethra. The aim of the study was to determine self-perception of health-related quality of life (HRQoL), ease of catheterization and global and cosmetic outcomes in patient's dependent on Mitrofanoff catheterization. Materials and methods: Records of all patients who underwent CUD with the Mitrofanoff principle between 2012 to 2018 were reviewed. Data were collected and analysed retrospectively from medical charts. We assessed HRQoL with the EuroQol EQ-5D-3L questionnaire, cosmetic and global satisfaction with a questionnaire designed by the reconstructive urology board and ease of catheterization with a Likert questionnaire adapted from the Intermittent Catheterization Difficulty Questionnaire (ICDQ) validated in patients reliant on retrograde CIC. Results: A total of 25 patients requiring CUD with the Mitrofanoff principle between 2012 and 2018 were assessed, the group was composed mainly of: appendiceal conduits 18 patients (72%) and 7 ileal conduits (Yang-Monti) and three of those requiring Casale (Monti Spiral) and 1 a double Monti technique. Median follow-up was 57 months, median age was 30 years. Visual Analogue Scale (VAS) of the EQ-5D-3L reported a Global health score of 86.5%. Fifty nine percent of the patients had no pain or bleeding with catheterizations. Regarding global satisfaction and cosmetic perception 91% were satisfied with their CUD. Conclusions: CUD is associated with good HRQoL, global satisfaction, ease and painless catheterization, adequate self-perception of cosmetic outcomes and a low complication rate, remaining a safe and viable option.
Utility of Mitrofanoff as bladder draining tool: A single center experience in pediatric patients
Türk Üroloji Dergisi/Turkish Journal of Urology, 2018
Objective: Mitrofanoff procedure has been employed commonly as bladder draining tool in patients unable to do clean intermittent self catheterization through native urethera. Single centre experience of pediatric age group patients undergoing Mitrofanoff procedure has been presented here. Material and methods: It was a retrospective study of 29 children who underwent continent catheterizable conduit (CCC), from January 2009 till March 2017. Charts were reviewed for age, gender, presenting complaints, need for augmentation cystoplasty, Mitrofanoff channel source such as appendix or ileal patch, duration of surgery in minutes, hospital stay in days, per operative and postoperative complications. Preoperative evaluation of the children was done by doing complete blood picture, serum electrolytes, and renal function tests. Radiological evaluation included ultrasound kidney,ureter and bladder, voiding cystourethrography, urodynamic analysis and a nuclear renal scan with 99m Technetium dimercapto-succinic acid or MAG-3 scan. The abdominal end of the conduit was brought through the abdominal wall, and a stoma was fashioned by the V-quadrilateral-Z technique. Results: Twenty nine children having mean age of 9.54±4.88 years underwent CCC. There were 19 males (65.51%) and 10 females (34.48%). Children who underwent CCC included 18 children having neurogenic bladder, 2 cases of urethral trauma/stricture 3 patients with history of posterior uretheral valve and 6 patients with exstrophy bladder. Augmentation cystoplasty plus mitrofanoff was done in 18 children while only mitrofanoff in 11 children. Stuck catheter was seen in one patient which was removed successfully via normal urethral route under general anesthesia. Stomal stenosis in first year was noted in 4 patients (13.79%). Conclusion: Continent catheterizable conduit based on Mitrofanoff principle have durable outcome over long term follow up in terms of urinary continence and complications.
Laparoscopy-Assisted Catheterizable Continent Urinary Conduits
Pediatric Endosurgery & Innovative Techniques, 2000
Purpose: A laparoscopy-assisted approach to the creation of catheterizable continent urinary conduits provides enhanced surgical exposure and allows complex reconstruction to be performed through small and cosmetically appealing incisions. Patients and Methods: Clinical experience with six myelodysplastic children (five boys, one girl; mean age 11.3 years) undergoing laparoscopy-assisted appendicovesicostomy and ileal augmentation cystoplasty over a 7-month interval is compared with published reports. One 10-mm umbilical camera port and two 5-mm working ports were used in four children. In the two others, a hand-assisted laparoscopic approach using the Dexterity ® Pneumo Sleeve™ set was used. Results: All six children underwent successful creation of an appendicovesicostomy with an umbilical stoma after extensive laparoscopic mobilization of the ascending colon. Thereafter, ileal bladder augmentation was performed in all six through a Pfannenstiel incision. A bladder neck wrap procedure was also completed in three of the boys. Laparoscopic dissection times ranged from 30 to 80 minutes. Postoperative pain control and length of hospitalization (mean 5 days) were improved in comparison with a standard approach using an extended lower midline abdominal incision. Conclusions: Laparoscopy-assisted mobilization of the right colon and appendiceal mesentery promotes optimal placement of the appendicovesicostomy stoma within the umbilicus and allows the remainder of planned urinary tract reconstruction to be completed through a Pfannenstiel incision. Cosmetic appearance is enhanced, and perioperative morbidity is minimized.