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The continent, catheterizable abdominal conduit in adult urological practice
Author(s) -
Gowda Basavaraj D.R.,
Agrawal Vineet,
Harrison Simon C.W.
Publication year - 2008
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2008.07885.x
Subject(s) - medicine , surgery , bladder augmentation , urinary diversion , appendix , neck of urinary bladder , electrical conduit , laparotomy , urinary system , urethra , urinary bladder , cystectomy , bladder cancer , mechanical engineering , paleontology , cancer , engineering , biology
OBJECTIVE To report a large, single‐centre experience with a continent, catheterizable abdominal conduit in adult patients. PATIENTS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.