The place of Mitrofanoff neourethra in the repair of exstrophy-epispadias complex.

The authors present their experience with seven patients having an exstrophy-epispadias complex who had undergone Young-Dees-Leadbetter bladder neck reconstruction with an adjuvant Mitrofanoff neourethra. All the patients, but one, were male with a mean age of 7.4 +/- 3.9 years. Six of them had had previous primary closure of their exstrophied bladders accompanied by anterior diagonal iliac osteostomies, and one having pure epispadias had an incompetent bladder neck and a very low bladder capacity. Four of these patients had breakdown of their reconstructed bladder necks due to clean intermittent catheterization (CIC) via urethra. Ileocystoplasties were performed in all of the patients for their unacceptably low bladder capacities (mean 20.9 +/- 12.9 ml) with an adjuvant Mitrofanoff neourethra. The patients were put on CIC every 3-4 hours via Mitrofanoff channel. Six were totally continent, and one had to use a pad during daytime. There were no complications related to the Mitrofanoff stoma except two patients complained about temporary difficulty on catheterization. The authors conclude that incorporating a Mitrofanoff stoma to bladder neck reconstruction procedures in exstrophy-epispadias complex, prevents injury to the bladder neck during CIC, and thus lowers the risk and incidence of failure.