Continent Urinary Diversion with Short Appendices in Obese Patients: the Initial Results of a Surgical Option
Journal of Surgery
Volume 1, Issue 2, June 2013, Pages: 22-27
Received: May 15, 2013;
Published: Jun. 10, 2013
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Marcelo Ferreira Cassini, Division of Urology, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil
Antônio Antunes Rodrigues Júnior, Division of Urology, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil
Carlos Augusto Fernandes Molina, Division of Urology, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil
Adauto José Cologna, Division of Urology, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil
Alessandra Mazzo, Faculty of Nursing, of Ribeirao Preto, University of Sao Paulo, Brazil
SílvioTucci Júnior, Division of Urology, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil
Introduction: Many patients need to be submitted to a continent urinary derivation surgery. Lost of bladder compliance secundary to neurogenic bladder injuries, severe and untractable urethral stenos is are some of the main indications. We present here the initial results and outcomes of twelve procedures performed using the association between Mitrofanoff’s principle and Monti’s technique as a surgical option for a continenturinarydiversion in patients with short appendices or obese. Materials and Methods: We analyzed data from twelve patients who were submitted to ileocistoplasty and urinary continent derivation by association between Mitrofanoff’s principle and Monti’s technique performed from january2009 to december 2012 in our institution. In all patients the appendices were too short to reach the skin, some of them, because the obesity. Results: Twelve patients were submitted to the Mitrofanoff and Monti techniques association. The most common surgical complications were stoma skin stenosis (02 cases) and urinary leakage through the re-opened bladder neck in 02 patients. Urinary infection (01 sepse) was the main clinical complication. Eleven patients are totally adapted to intermittent clear catheterization through the naveland satisfyed with urinary continence and quality of life.There were no deaths and no urinary or intestinal fistulas secondary to the procedure. Conclusions: The association between Mitrofanoff’s principle and Monti’s technique is safe, feasible and a very useful alternative in urologic cases, (i.e., severe and untractable urethral stenos is and low compliance neurogenic bladder, for example) of continent urinary diversion, when the ileocecal appendix is too short to reach the skin (i.e., obese patients).
Marcelo Ferreira Cassini,
Antônio Antunes Rodrigues Júnior,
Carlos Augusto Fernandes Molina,
Adauto José Cologna,
Continent Urinary Diversion with Short Appendices in Obese Patients: the Initial Results of a Surgical Option, Journal of Surgery.
Vol. 1, No. 2,
2013, pp. 22-27.
Lapides J, Diokno AC, Silber SJ, Lowe BS. Clean intermitente self-catheterization in the treatment of urinary tract disease. J Urol. 1972, Mar;107(3):458-461.
Mitrofanoff P. Trans-appendicular continent cystostomy in the management of the neurogenic bladder. ChirPediatr 1980; 21: 297-305.
Yang WH. Yang needle tunneling technique in creating anti-reflux and continent mechanisms. J Urol. 1993;150:830-834.
Monti PR, Lara RC, Dutra MA, de Carvalho JR. New techniques for construction of efferent conduits based on the Mitrofanoff principle. Urology 1997;49:112-115.
Farrugia MK, Malone PS. Educational article: the Mitrofanoff procedure. J Pediatric Urol. 2010,6: 330-337.
Blaivas JG, et al. Detrusor-external sphincter dyssynergia. J Urol. 1981, Apr; 125(4): 542-544.
Rodrigues Jr AA, Cassini MF, TucciJr S, Cologna AJ, Reis RB, Martins ACP, Suaid HJ. Using Mitrofanoff’s principle and Monti’s technique as a surgical option for bladder augmentation with a continent stoma: a case report. J Med Case Report 2011, 5:49-51.
Hosseini J, Kaviani A, Mazloomfard MM, Golshan AR. Monti’s procedure as an alternative technique in complex urethral distraction defect. IntBraz J Urol 2010, 36(3); 317-326.
Coffey RC. Physiologic implantation of the severed ureter or common bile duct into the intestine. JAMA 191;56:397-403.
Eshghi M, Bronsther B, Ansong K, Hanna MK, Smith AD. Technique and trial of continent ileocystostomy. Urology 1986 Feb;27(2):112-116.
Ardelt PU, Woodhouse CRJ, Riedmiller H, Gerharz EW. The efferent segment in continent cutaneous urinary diversion: a comprehensive reviem of the literature. BJUInt. 2011;109:288-297.
Piaggio L, Myers S, Figueroa T E, Barthold J S, Gonzalez R. Influence of type of conduit and site of implantation on the outcome of continent catheterizable channels. J PediatrUrol 2007;3:230-234.
Van Savage JG, Khoury AE, McLorie GA, Churchill BM. Outcome analysis of Mitrofanoff principle applications using appendix and ureter to umbilical and lower quadrant stomal sites. J Urol 1996;156:1794e7.
McAndrew HF, Malone PS. Continent catheterizable conduits: which stoma, which conduit and which reservoir? BJU Int. 2002;89:86-89.
Narayanaswamy B, Wilcox DT, Cuckow PM, Duffy PG, Ransley PG. The Yang-Monti channel and appendix for continent diversion in the Mitrofanoff and Malone principles. BJU Int. 2001;87:861-865.
Lemelle JL, Simo AK, Schmitt M. Comparative study of the Yang-Monti channel and apêndix for continent diversion in the Mitrofanoff and Malone principles. J Urol. 2004;172(5 Pt 1):1907-1910.
Castellan MA, Gosalbez R, Labbie A, Ibrahim E, DiSandro M. Outcomes of continent catheterizable stomas for urinary and diversion: their nature and timing. J Urol. 2008;180(Suppl. 4):1856-1860.
Roth CC, Donovan BO, Tonkin JB, Klein JC, Frimberger D, Kropp BP. Endoscopic injection of submucosalcatheterizable channels. J Pediatr Urol. 2009;5:265-268.
Kavanagh A, Afshar K, Scott H, MacNeily AE. Bladder neck closure in conjunction with enterocystoplasty and Mitrofanoff diversion for complex incontinence: closing the door for good. J Urol. 2012;188: 1561-1566.
Dave S and Khoury AE. Bladder outlet surgery for incontinence and neurogenic bladder. AUA Up-date Series 2010; 29 Lesson 27.
Kass EJ, Koff SA, Diokno AC, Lapides J. The significance of bacilluria in children on long-term intermittent catheteriza- tion. J Urol 1981;126:223e5.
Blok BF, Karsenty G, Corcos J. Urological surveillance and management of patients with neurogenic bladder: results of a survey among practicing urologists in Canada. Can J Urol 2006;13:3239e43.
Van Nieuwkoop C, Den Exter PL, Elzevier HW, Den Hartigh J, Van Dissel JT. Intravesical gentamicin for recurrent urinary tract infection in patients with intermittent bladder catheterization. Int J Antimicrob Agents, 2010;36(6):485-490.
Clarke SA, Samuel M, Boddy SA. Are prophylactic antibiotics necessary with clean intermittent catheterization? A randomized controlled trial. J PediatrSurg 2005;40:568e71.
Franc-Guimond J, Gonzalez R. Effectiveness of implanting catheterizable channels into intestinal segments. J PediatrUrol 2006;17:1088-1091.
Macneily AE, Morrell J, Secord S. Lower urinary tract reconstruction for spina bifida – does it improve health related quality of life? J Urol. 2005;174(4 Pt 2):1637-1643.
Parekh AD, Trusler LA, Pietsch JB, Byrne DW, et al. Prospective, longitudinal evaluation of health related quality of life in the pediatric spina bifida population undergoing reconstructive urological surgery. J Urol. 2006; 176(4 Pt 2):1878-1882.
Aslan AR, Kogan BA. Conservative management in neurogenic bladder dysfunction. CurrOpin Urol. 2002;12(6):473-477.