Abstract
Treatment of children with severe impairment of bladder function requires 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 bladder exstrophy in 8 (2 girls), neuropathic bladder in 3 (2 girls), urethral valves in 2, and rhabdomyosarcoma (RMS) in 2. In 10 patients bladder augmentation with an intestinal patch was performed in addition to a Mitrofanoff procedure; in 5 a neobladder and continent appendicostomy were made. One boy with RMS died of distant metastases with a well-functioning appendicostomy and adequate renal function. At 2 to 9 years 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 preexisting impairment of renal function, further deterioration necessitated frequent catheterization and additional medical treatment. In I boy with fulgurated urethral valves, spontaneous micturition became subsequently possible, allowing closure of his appendicovesicostomy. Complications occurred in 10 patients, necessitating reintervention in 7. The MP in combination with the creation of an adequate reservoir gives good results in children with severe impairment of bladder function. Careful attention should be given to patient education regarding emptying of the reservoir. Long-term follow-up of renal function is mandatory.
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Duckett JW, Snyder HM (1986) Continent urinary diversion: variations on the Mitrofanoff principle. J Urol 136: 58–62
Dykes EH, Duffy PG, Ransley PG (1991) The use of the Mitrofanoff principle in achieving clean intermittent catheterisation and urinary continence in children. J Pediatr Surg 26: 535–538
Elder JS (1992) Continent appendicocolostomy: a variation of the Mitrofanoff principle in pediatric urinary tract reconstruction. J Urol 148: 117–119
Heij HA, Vos A, Kraker J de, Voute PA (1993) Urogenital rhabdomyosarcoma in children: is a conservative approach justified? J Urol 150: 165–168
Hendren WH, Hendren RB (1990) Bladder augmentation: experience with 129 children and young adults. J Urol 144: 445–453
Husmann DA, Spence HM (1990) Current status of tumor of the bowel following ureterosigmoidostomy: a review. J Urol 144: 607–610
Lander EB, Shanberg AM, Tansey LA, Sawyer DE, Groncy PK (1992) The use of continent diversion in the management of rhabdomyosarcoma of the prostate in childhood. J Urol 147: 1602–1605
Leonard MP, Gearhart JP, Jeffs RD (1990) Continent urinary diversion reservoirs in pediatric urological practice. J Urol 144: 330–333
Mitrofanoff P (1980) Cystostomie continente trans-appendiculaire dans le traitement des vessies neurologiques. Chir Pediatr 21: 297–305
Rowland RG (1986) Editorial: continent urinary diversion. J Urol 136: 76
Woodhouse CR, Gordon EM (1994) The Mitrofanoff principle for urethral failure. Br J Urol 73: 55–60
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Heij, H.A., Ekkelkamp, S., Moorman-Voestermans, C.G.M. et al. Application of the Mitrofanoff principle in children with severe impairment of bladder function. Pediatr Surg Int 12, 286–288 (1997). https://doi.org/10.1007/BF01372151
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DOI: https://doi.org/10.1007/BF01372151