• Logo
  • SBMUJournals

Appendicovesicostomy as an Alternative Procedure for Patients with Complex Urethral Distraction Defect

Amir Reza Abedi, Saleh Ghiasy, Morteza Fallah-karkan, Seyyed Ali Hojjati, Jalil Hosseini
132

Views


Abstract

Purpose: Surgi­cal repair of post-traumatic complex urethral stricture poses a major challenge to urologists. Here, we report six patients with irreparable urethral strictures who were successfully treated by using the appendix as conduit for urinary diversion.

Materials and Methods: Six patients who had underwent urinary diversion using an appendix during 2015 to 2019 were included in our study. All patients had a history of one or more failed attempts of urethral reconstruction in the past. Mean follow-up for patients was 29 months. Continency was defined as being completely dry for at least3 hours.

Results: Mean age of patients was 40.1 years old (range: 20-70 years). Intermittent catheterization through the conduit was easily performed for every patient without any stomal stenosis. Mild stomal incontinence only occurred in one case which was resolved after a few months. All patients were continent during day and night.

Conclusion: Based on the results of our study, Mitrofanoff’s technique is a valuable procedure for managing patients with serious complicated urethral strictures who cannot be treated with common standard approaches.


Keywords

urethral stricture; urinary diversion; appendix diversion; Mitrofanoff’s; Appendicovesicostomy

References

Webster GD, Ramon J. Repair of pelvic fracture posterior urethral defects using an elaborated perineal approach: experience with 74 cases. The Journal of urology. 1991;145:744-8.

Mirzazadeh M, Fallahkarkan M, Hosseini J. Penile fracture epidemiology, diagnosis and management in Iran: a narrative review. Translational andrology and urology. 2017;6:158.

Gibson GR. Urological management and complications of fractured pelvis and ruptured urethra. The Journal of urology. 1974;111:353-5.

Hosseini J, Tabassi KT. Surgical repair of posterior urethral defects: review of literature and presentation of experiences. Urology journal. 2008;5:215-22.

Hampson LA, McAninch JW, Breyer BN. Male urethral strictures and their management. Nature Reviews Urology. 2014;11:43.

Mathur R, Nayak D, Aggarwal G, Shukla A, Khan F, Odiya S. A retrospective analysis of urethral strictures and their management at a tertiary care center. 2011.

Andrich D, Mundy A. Substitution urethroplasty with buccal mucosal-free grafts. The Journal of urology. 2001;165:1131-4.

Barbagli G, De Angelis M, Romano G, Lazzeri M. Long-term followup of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. The Journal of urology. 2007;178:2470-3.

Wu D-L, Jin S-B, Zhang J, Chen Y, Jin C-R, Xu Y-M. Staged pendulous-prostatic anastomotic urethroplasty followed by reconstruction of the anterior urethra: an effective treatment for long-segment bulbar and membranous urethral stricture. European urology. 2007;51:504-11.

Kinnaird AS, Levine MA, Ambati D, Zorn JD, Rourke KF. Stricture length and etiology as preoperative independent predictors of recurrence after urethroplasty: A multivariate analysis of 604 urethroplasties. Canadian Urological Association Journal. 2014;8:E296.

Chapple C, Barbagli G, Jordan G, et al. Consensus statement on urethral trauma. BJU international. 2004;93:1195-202.

Xu Y-M, Qiao Y, Sa Y-L, et al. Substitution urethroplasty of complex and long-segment urethral strictures: a rationale for procedure selection. European urology. 2007;51:1093-9.

Hosseini J, Kaviani A, Mazloomfard MM, Golshan AR. Monti’s procedure as an alternative technique in complex urethral distraction defect. International braz j urol. 2010;36:317-26.

Scorer C. The Suprapubic Catheter A Method Of Treating Urinary Retention. The Lancet. 1953;262:1222-5.

Myers JB, McAninch JW. Perineal urethrostomy. BJU international. 2011;107:856-65.

Santucci RA, McANINCH JW, Mario LA, et al. Urethroplasty in patients older than 65 years: indications, results, outcomes and suggested treatment modifications. The Journal of urology. 2004;172:201-3.

Freitas Filho LGd, Carnevale J, Melo Filho A, Vicente N, Heinisch A, Martins JL. Posterior urethral injuries and the Mitrofanoff principle in children. BJU international. 2003;91:402-5.

Lemelle J, Simo AK, Schmitt M. Comparative study of the Yang-Monti channel and appendix for continent diversion in the Mitrofanoff and Malone principles. The Journal of urology. 2004;172:1907-10.

Gerharz EW, Köhl UN, Melekos MD, Bonfig R, Weingärtner K, Riedmiller H. Ten years’ experience with the submucosally embedded in situ appendix in continent cutaneous diversion. European urology. 2001;40:625-31.

Simforoosh N, Razzaghi M, Danesh A, Sharifi F, Gholamrezaie H, Mousavi H. Continent ileocecal diversion with an unaltered in situ appendix conduit. The Journal of urology. 1998;159:1176-8.

Mitrofanoff P. Cystostomie continente trans-appendiculaire dans le traitement des vessies neurologiques. Chir. Pediatr. 1993;150:830-4.

Turner-Warwick R. Prevention of complications resulting from pelvic fracture urethral injuries--and from their surgical management. The Urologic clinics of North America. 1989;16:335-58.

Filipas D, Fisch M, Leissner J, Stein R, Hohenfellner R, Thüroff J. Urinary diversion in childhood: indications for different techniques. BJU international. 1999;84:897.

Gowda BD, Agrawal V, Harrison SC. The continent, catheterizable abdominal conduit in adult urological practice. BJU international. 2008;102:1688-92.

Mohr AM, Pham AM, Lavery RF, Sifri Z, Bargman V, Livingston DH. Management of trauma to the male external genitalia: the usefulness of American Association for the Surgery of Trauma organ injury scales. The Journal of urology. 2003;170:2311-5.

Kobayashi M, Nomura M, Yamada Y, Fujimoto N, Matsumoto T. Bladder‐sparing surgery and continent urinary diversion using the appendix (Mitrofanoff procedure) for urethral cancer. International journal of urology. 2005;12:581-4.

Hakenberg OW, Ebermayer J, Manseck A, Wirth MP. Application of the Mitrofanoff principle for intermittent self-catheterization in quadriplegic patients. Urology. 2001;58:38-42.

Yang W-H. Yang needle tunneling technique in creating antireflux and continent mechanisms. The Journal of urology. 1993;150:830-4.

Harris CF, Cooper CS, Hutcheson JC, SNYDER HM. Appendicovesicostomy: the Mitrofanoff procedure—a 15-year perspective. The Journal of urology. 2000;163:1922-6.

Cain MP, Casale AJ, King SJ, Rink RC. APPENDICOVESICOSTOMY AND NEWER ALTERNATIVES FOR THE MITROFANOFF PROCEDURE: RESULTS IN THE LAST 100 PATIENTS AT RILEY CHILDREN′ S HOSPITAL. The Journal of urology. 1999;162:1749-52.

Okada Y, Ogura K, Ueda T, et al. Urinary reconstruction using appendix as a urinary and catheterizable conduit in 12 patients. International journal of urology. 1997;4:17-20.

Chen K-C, Lai W-M, Chen Y-K, Chiang H-S. The Use of the Appendix or Tapered Ileal Segment as a Continent Cathererizable Efferent Limb of Urinary Reservior. 輔仁醫學期刊. 2005;3:69-74.

Aggarwal SK, Goel D, Gupta CR, Ghosh S, Ojha H. The use of pedicled appendix graft for substitution of urethra in recurrent urethral stricture. Journal of pediatric surgery. 2002;37:246-50.

Sgourakis G, Sotiropoulos GC, Molmenti EP, et al. Are acute exacerbations of chronic inflammatory appendicitis triggered by coprostasis and/or coproliths? World Journal of Gastroenterology: WJG. 2008;14:3179.

Tsuji I, Kuroda K, Ishida H. A new method for the reconstruction of the urinary tract: bladder flap tube. The Journal of urology. 1959;81:282-6.




DOI: http://dx.doi.org/10.22037/uj.v0i0.5592

Refbacks

  • There are currently no refbacks.