The Mitrofanoff procedure in the management of intractable incontinence: a critical appraisal.

PURPOSE OF REVIEW: The term intractable urinary incontinence can be applied to urinary incontinence that cannot be managed using conventional treatments like drug therapy for detrusor overactivity or sling procedures for female stress incontinence. This review considers the role of the Mitrofanoff procedure in extending the range of options for the patient who might otherwise consider using an indwelling catheter or an ileal conduit diversion to overcome incontinence. Clinicians use the label 'Mitrofanoff procedure' quite loosely to describe any continent catheterizable abdominal stoma. For the purposes of this review, we will use the term in this generic sense while acknowledging our imprecision.

RECENT FINDINGS: Reviews confirm that the Mitrofanoff procedure has stood the test of time. Quality-of-life benefits, however, need a conclusive demonstration in scientific terms. Enthusiasts of laparoscopic surgery show that this type of lower urinary tract reconstruction can be carried out using minimally invasive methods.

SUMMARY: Reconstructive options using a catheterizable abdominal stoma should be discussed with patients with intractable urinary incontinence. Reliable surgical techniques are established; though complications are frequent, most can be dealt without recourse to major surgical intervention. Unfortunately, authoritative data on the impact of the Mitrofanoff procedure on patients' qualities of life are still lacking.