Appendicovesicostomy as an Alternative Procedure for Patients with Complex Urethral Distraction Defect
Vol. 17 No. 4 (2020),
24 June 2020
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 least 3 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.
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.
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