Continent urinary diversion: variations on the Mitrofanoff principle.

In 1980 Mitrofanoff described a continent urinary diversion, consisting of the bladder with a surgically closed bladder neck emptied by intermittent catheterization of the appendix, which had its distal end implanted in a submucosal nonrefluxing fashion in the bladder and its proximal end brought out as an inconspicuous stoma. Alternatively, Mitrofanoff described a high transureteroureterostomy in which the distal end of the ureter was brought out as a catheterizable stoma. The theme of this approach is the creation of an adequate capacity storage reservoir that is emptied intermittently by the catheterization of a small caliber conduit implanted in a nonrefluxing manner in the reservoir. In addition to the Mitrofanoff procedure, we have modified the principle in a variety of clinical situations and report 10 cases to demonstrate the value of this new concept in continent urinary diversion.