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At least 1,171 records · Page 65Linked to original sources
PubMed1997

Results of the Mitrofanoff procedure in urinary tract reconstruction in children.

OBJECTIVES: To evaluate the success and long-term complications associated with the use of continent catheterizable conduits based on the Mitrofanoff principle in children. PATIENTS AND METHODS: The records of 43 patients (21 female and 22 male) who underwent the construction of a continent catheterizable stoma based on the Mitrofanoff principle between 1987 and 1996 were reviewed retrospectively. The mean age at surgery was 10 years (range 3-21) and the mean follow-up was 3 years (range 0.5-6.5). Twenty-eight of the 43 children underwent augmentation cystoplasty in conjunction with the Mitrofanoff procedure, using ileum in 17, sigmoid in seven, caecum in two and stomach in one; detrusormyectomy was performed in one child. Fifteen patients had only a continent catheterizable stoma formed. The most common type of conduit was appendicovesicostomy (36 of 43 children): other conduits were constructed with ureter (four), tapered ileum (two) and fallopian tube (one). RESULTS: Stomal continence was achieved in 42 of 43 patients (98%). The most common late complication was difficulty in catheterization, which occurred in 14 patients (32%). Stomal prolapse requiring revision occurred in one patient (2%). Conduit dilatation was initially attempted in all patients with difficult catheterization, although it failed in 11 who then required surgical revision. Therefore, the overall revision rate was 28% (12 of 43). The site of stomal placement (umbilical or abdominal) did not significantly influence the risk of difficulty with catheterization. CONCLUSION: The Mitrofanoff procedure can simplify catheterization in children who are dependent upon intermittent catheterization. The vermiform appendix appears to be the best source for constructing the conduit. While stomal continence is excellent, conduit stenosis remains a frequent complication regardless of stomal location.

Adolescent↗
PubMed1980

Pre-operative and post-operative evaluation of the rectal bladder.

Five Heitz-Boyer-Hovelacque operations in children were reviewed in which particular attention was paid to pre-operative examinations, including electromanometry (EMM) and post-operative evaluation of continence, functional result and renal function. In our limited experience the rectal bladder operation is a good procedure in selected cases; it produces satisfactory continence and maintains renal function.

Adolescent↗
PubMed1991

[The AS800 artificial sphincter for the treatment of female incontinence].

From 1983 to May 1991, the artificial sphincter AS800 has been applied in 106 female patients for the treatment of complicated cases of urinary incontinence. Of these, 80 remained in continuous follow-up and have now been followed up for at least 1 year, with a mean of 3.8 years. In 40 of our female patients the urethra was afunctional secondary to failure of previous anti-stress-incontinence procedures. Neurogenic incontinence with sphincteric involvement affected 30, while 10 of the patients had congenital sphincter anomalies or traumatic sphincter weakness. Following implantation of the artificial sphincter, 86.3% of these patients are completely continent and do not need a pad. With regard to emptying, 81.3% are able to empty their bladder without residual urine after opening the sphincter, and 8 have to perform clean intermittent catheterization (CIC) once or twice daily in addition. A further 7 void exclusively by CIC. As preparation for implantation of the AS800 sphincter, 24 additional procedures were performed, including 5 antireflux operations and 6 bladder-flap procedures. In 38 of 80 patients a total of 62 revisions were performed. Infection and erosion were the most common reasons for revision, accounting for 48.2% of all revisions. The next most common reason was tissue atrophy underneath the cuff. However, 25% of the revisions were due to device failures, most often cuff leakage.

Adolescent↗
PubMed1988

Bladder augmentation in the pediatric age group.

In summary, enterocystoplasty has become an effective, safe and very useful addition to management of vesical dysfunction in children. The use of bladder augmentation has become more universally accepted with the recognition of the safety of clean intermittent catheterization and the development of efficient antireflux mechanisms when ureteral reimplantation into the bowel is required. However, the surgeon who wishes to participate in this endeavor must have a solid foundation and understanding of vesical urodynamics and must be committed to offering these children an ongoing program to manage their life-long problems associated with their primary disease as well as the special need associated with augmentation procedures.

Bladder Exstrophy↗
PubMed1996

[Replacement continent bladder in dogs by opening an antro-pyloric graft onto the abdominal wall (seven cases between 1980 and 1983)].

To determine the usefulness of antral bladder controlled by the pyloric sphincter denervated for urological applications, bladder replacement was performed in 17 dogs using the antral segment with its own sphincter, initially with the pylorus supplied by the left gastro-epiploic artery, and later by the right gastro-epiploic artery. The smooth pyloric muscle was denervated to obtain permanent spasm and pulled through the striated anterior abdominal muscle. Both ureters were anastomosed by a Cohen's procedure. The best results were obtained with a gastric pouch supplied by the right gastro-epiploic artery; dissection and reimplantation of the ureters in the gastric wall are difficult. IVP and cystography indicated good function of the antral pouch, with no reflux. The antral bladder controlled by the denervated pyloric sphincter could be a possible alternative in the surgical management of neurogenic or exstrophic bladder.

Abdominal Muscles↗
PubMed1984

Prospective management of exstrophy of the cloaca and myelocystocele following prenatal ultrasound recognition of neural tube defects in identical twins.

We describe identical twins concordant for exstrophy of the cloaca and myelocystocele. Their management and subsequent course was strongly influenced by prenatal ultrasound recognition of neural tube defects in both twins and severe renal dysplasia in one of the fetuses. The genetic aspects of this case are consistent with existing causal theories of exstrophy of the cloaca.

Abnormalities, Multiple↗
PubMed2005

Pseudoexstrophy with epispadias.

The exstrophy variants are uncommon anomalies. The variants of the exstrophy complex have all the stigmata of the classical exstrophy such as divergent recti, widened symphysis pubis, and low-set umbilicus; however, the urinary tract is intact to a varying degree. Pseudoexstrophy, an exstrophy variant, is very rarely associated with epispadias. We report an unusual case of pseudoexstrophy with epispadias, in whom the intact bladder was initially covered by a mucous membrane which later epithelialized. The epispadias was repaired using a penile disassembly technique with posterior and ventral placement of bladder neck and urethra. Although the urethral meatus was hypospadiac, the child had achieved dry intervals with occasional stress incontinence.

Bladder Exstrophy↗
PubMed1998

The transverse ileal tube as second-line modification of the Mitrofanoff principle.

With the advantages of constant availability, minimal loss of bowel, relative simplicity (no mesentery interfering with implantation, high mobility of the tube), minimized risk of stone formation (no use of staples), reliable continence (no leak point) and easy catheterization (longitudinal folds), this straightforward technique is an excellent second choice for the Mitrofanoff conduit. A longer period of follow-up is needed to determine whether it deserves a permanent place in the reconstructive surgeons' repertoire.

Adolescent↗