Urology · 2011
Pilot study of the vesicocutaneous continent catheterizable stoma (mitrofanoff) in adults--high complication rates.
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Eisenberg Lauren, Johnson Jeremy, Santucci Richard
Аннотация
OBJECTIVE: To report our experience with an adult vesicocutaneous Mitrofanoff, an alternative to standard appendiceal or ileal Mitrofanoff.
MATERIAL AND METHODS: Retrospective chart review was performed on 3 patients who underwent a vesicocutaneous Mitrofanoff by a single surgeon. Data were collected on etiology, complications, and number of procedures to correct the complication.
RESULTS: Indications for the procedure included neurogenic bladder and urinary retention. Mean follow-up time was 485 days with mean time to first complication of 24 days. One-hundred percent of patients saw stenosis and dehiscence of their wounds. All 3 patients required subsequent surgery. Sixty-six percent required reoperation to the standard Mitrofanoff with a mean time to this procedure of 222 days. The mean number of procedures was 4 (range 2-6).
CONCLUSION: Continent catheterizable stomas have been a continuous challenge for adults who have had multiple abdominal surgeries, making a typical appendix, ureter, or small bowel Mitrofanoff difficult. We looked at our experience with a cutaneous Mitrofanoff (an extraperitoneal procedure often done in pediatrics but never before in adults) as an alternative but found complication rates of 100%. These included stenosis and dehiscence eventually requiring reoperation, with some even requiring conversion to an ileal or appendiceal Mitrofanoff. Although there are high complication rates in the standard Mitrofanoff, we conclude that a vesicocutaneous Mitrofanoff is not an effective alternative.
MATERIAL AND METHODS: Retrospective chart review was performed on 3 patients who underwent a vesicocutaneous Mitrofanoff by a single surgeon. Data were collected on etiology, complications, and number of procedures to correct the complication.
RESULTS: Indications for the procedure included neurogenic bladder and urinary retention. Mean follow-up time was 485 days with mean time to first complication of 24 days. One-hundred percent of patients saw stenosis and dehiscence of their wounds. All 3 patients required subsequent surgery. Sixty-six percent required reoperation to the standard Mitrofanoff with a mean time to this procedure of 222 days. The mean number of procedures was 4 (range 2-6).
CONCLUSION: Continent catheterizable stomas have been a continuous challenge for adults who have had multiple abdominal surgeries, making a typical appendix, ureter, or small bowel Mitrofanoff difficult. We looked at our experience with a cutaneous Mitrofanoff (an extraperitoneal procedure often done in pediatrics but never before in adults) as an alternative but found complication rates of 100%. These included stenosis and dehiscence eventually requiring reoperation, with some even requiring conversion to an ileal or appendiceal Mitrofanoff. Although there are high complication rates in the standard Mitrofanoff, we conclude that a vesicocutaneous Mitrofanoff is not an effective alternative.