Efficacy and Complications of Mitrofanoff Continent Urinary Diversion in Adults with Complex Urethral Strictures: A Single-Center Experience
Urology Journal,
Vol. 21 No. 06 (2024),
27 November 2024
,
Page 404-409
https://doi.org/10.22037/uj.v21i.8190
Abstract
Purpose: The management of complicated and irreparable urethral strictures can be challenging, and continent
urinary diversion has emerged as a viable option. This study aims to investigate the complications associated with
continent urinary diversion using the Mitrofanoff principle in patients with complex urethral strictures that cannot
be corrected through urethroplasty surgery.
Materials and Methods: A total of 22 patients were included in this study, who underwent continent urinary diversion surgery using the Mitrofanoff technique. The patients were monitored for post-surgical complications over an average follow-up period of 28.36±14.26 months. Surgical failure was defined as the inability to completely and regularly empty urine from the new urinary tract.
Results: Half of the patients experienced surgical complications, with only one case resulting in surgery failure.
The most common complication observed was stoma stenosis. Two patients reported slight urinary leakage from
the stoma site. Notably, all patients except one, regained control over their urine after the procedure. Early therapeutic interventions were classified according to the Clavien-Dindo grading system, showed that none of the
patients experienced severe complications (grade 4 or 5).
Conclusion: The study examines the outcomes of continent urinary diversion using the Mitrofanoff technique in
adults with complex urethral strictures, providing realistic expectations of complications. Overall, the study shows
that this approach is a viable option with a high success rate and manageable complication for individuals with
complex urethral strictures that cannot be corrected through urethroplasty surgery.
- urinary diversion
- vesicostomy
- urethral stricture
How to Cite
References
Tritschler S, Roosen A, Füllhase C, Stief CG, Rübben H. Urethral stricture: etiology, investigation and treatments. Dtsch Arztebl Int. 2013;110:220.
Kong JP, Bultitude MF, Royce P, Gruen RL, Cato A, Corcoran NM. Lower urinary tract injuries following blunt trauma: a review of contemporary management. Rev Urol. 2011;13:119.
Koraitim MM. Pelvic fracture urethral injuries: evaluation of various methods of management. J Urol. 1996;156:1288-91.
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. Nephrourol Mon. 2011;3:109-13.
Hwang EC, De Fazio A, Hamilton K, Bakker C, Pariser JJ, Dahm P. A systematic review of randomized controlled trials comparing buccal mucosal graft harvest site non-closure versus closure in patients undergoing urethral reconstruction. World J Mens Health. 2022;40:116.
Kulkarni S, Joshi PM, Bhadranavar S. Advances in urethroplasty. Med J Armed Forces India. 2023;79:6-12.
Abedi AR, Ghiasy S, Fallah-Karkan M, Hojjati SA, Hosseini J. Appendicovesicostomy as an alternative procedure for patients with complex urethral distraction defect. Urol J. 2020;17:386.
Mitrofanoff P. Trans-appendicular continent cystostomy in the management of the neurogenic bladder. Chir Pediatr. 1980;21:297-305.
Lemelle J, Simo AK, Schmitt M. Comparative study of the Yang-Monti channel and appendix for continent diversion in the Mitrofanoff and Malone principles. J Urol. 2004;172:1907-10.
O'Connor EM, Foley C, Taylor C, Malde S, Raja L, Wood DN, et al. Appendix or Ileum—Which is the Best Material for Mitrofanoff Channel Formation in Adults? J Urol. 2019;202:757-62.
Levy ME, Elliott SP. Reconstructive techniques for creation of catheterizable channels: tunneled and nipple valve channels. Transl Androl Urol. 2016;5:136.
Turner-Warwick R. Prevention of complications resulting from pelvic fracture urethral injuries—and from their surgical management. Urol Clin North Am. 1989;16:335-58.
Filipas, Fisch, Leißner, Hohenfellner, Thüroff. Urinary diversion in childhood: indications for different techniques. BJU Int. 1999;84:897-904.
Lecoanet P, Pascal G, Khaddad A, Hubert N, Lemelle J-L, Berte N, et al. Robot-assisted continent urinary diversion according to the Mitrofanoff principle: results of a bicentric study. World J Urol. 2021;39:2073-9.
Chen S, Wu Y, Zhang P, Li Z, Li X, Li Z, et al. Laparoscopic continent cutaneous urinary diversion using a modified Yang–Monti technique in an adult: A case report including 5-year follow-up. Curr Urol. 2022:10.1097.
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. Int J Urol. 2005;12:581-4.
Harris CF, Cooper CS, Hutcheson JC, Snyder HM. Appendicovesicostomy: the Mitrofanoff procedure—a 15-year perspective. J Urol. 2000;163:1922-6.
Smith G, Carroll D, Mukherjee S, Aldridge R, Jayakumar S, McCarthy L, et al. Health-related quality of life in patients reliant upon mitrofanoff catheterisation. Eur J Pediatr Surg. 2011:263-5.
Hebert KJ, Matta R, Myers JB. Patient Selection and Outcomes of Urinary Diversion. Urol Clin North Am. 2022;49:533-51.
Redshaw JD, Elliott SP, Rosenstein DI, Erickson BA, Presson AP, Conti SL, et al. Procedures needed to maintain functionality of adult continent catheterizable channels: a comparison of continent cutaneous ileal cecocystoplasty with tunneled catheterizable channels. J Urol. 2014;192:821-6.
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.
Veeratterapillay R, Morton H, Thorpe AC, Harding C. Reconstructing the lower urinary tract: The Mitrofanoff principle. Indian J Urol. 2013;29:316.
Zann A, Sebastiao Y, Ching CC, Fuchs M, Jayanthi VR, Wood RJ, et al. Split appendix Mitrofanoffs have higher risk of complication than intact appendix or monti channels. J Pediatr Urol. 2021;17:700. e1-. e6.
Harper L, Dunand O, Dobremez E. The fallow mitrofanoff. J Pediatr Urol. 2019;15:261. e1-. e4.
Kroll P, Gajewska E, Zachwieja J, Ostalska-Nowicka D, Micker M, Jankowski A. Continent catheterizable conduits in pediatric urology: One-center experience. Adv Clin Exp Med. 2017;26:1107-12.
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