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• W2024188613 abstract "No AccessJournal of UrologyPediatric Urology1 Sep 1999SALVAGE CONTINENT VESICOSTOMY AFTER ENTEROCYSTOPLASTY IN THE ABSENCE OF THE APPENDIX MONEER K. HANNA, FRANK RICHTER, and JEFFREY A. STOCK MONEER K. HANNAMONEER K. HANNA More articles by this author , FRANK RICHTERFRANK RICHTER More articles by this author , and JEFFREY A. STOCKJEFFREY A. STOCK More articles by this author View All Author Informationhttps://doi.org/10.1097/00005392-199909010-00069AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We describe a surgical procedure for a select group of children who had previously undergone augmentation enterocystoplasty, following which intermittent catheterization became more and more difficult or impractical. A new access to the reservoir became necessary, and alternative conduits included the appendix, ureter and tubularized ileum or stomach. Each conduit had its advantages and disadvantages but all required transperitoneal dissection. We report a simple extraperitoneal surgical technique that involves use of the Mitrofanoff and Nissen principles. Materials and Methods: A 2 × 6 cm. flap of the anterior wall, which is usually intestine, of the augmented bladder is raised. The base of the flap is just below the bladder dome. The flap is then tubularized over a 14F catheter and the cystostomy is closed. The bladder is plicated around the base of the tube, similar to the Nissen gastroesophageal fundoplication. The plication extends and covers the proximal 3 cm. of the tube. Intraoperative bladder distention is performed to confirm the competence of the continence mechanism. The distal part of the tube is then anastomosed to the inverted umbilical skin or to a tubularized abdominal wall skin flap. Results: The aforementioned technique was used in 5 children 3 months to 6 years old. Earlier augmentation ileocystoplasty and bladder neck reconstruction had been performed in 4 children. The appendix was unavailable for a Mitrofanoff vesicostomy in all cases. This procedure was also performed on a 13-year-old boy with severe myogenic detrusor failure, due to posterior urethral valves, and a bladder capacity of 700 ml. There was no significant surgical morbidity and all children are dry between clean intermittent catheterizations 1 to 5 years postoperatively (mean 3.3). Conclusions: Use of the Mitrofanoff and Nissen principles proved to be simple and reliable, and avoided secondary intraperitoneal exploration and use of bowel in these select cases. References 1 : Cystostomie continent trans-appendiculaire dans le traitement des vessies neurologiques. Chir. Ped.1980; 21: 297. Google Scholar 2 : Eine einfache operation zur Beeinflussung der refluxoesophagitis. Schwiz. Med. Wochenschr.1956; 86: 540. Google Scholar 3 : Continent urostomy with hydraulic ileal valve in 136 patients: 13 years of experience. J. Urol.1989; 142: 46. Link, Google Scholar 4 : Technique and trial of continent ileocystostomy. Urology1986; 27: 112. Google Scholar 5 : Continent vesicostomy: surgical technique. Urology1975; 6: 741. Google Scholar 6 : A new continent vesicostomy technique: preliminary report. J. Urol.1997; 157: 1633. Link, Google Scholar 7 : Continent vesicostomy using a catheterizable posterior bladder tube: modification of the Mitrofanoff principle. J. Ped. Surg.1994; 29: 71. Google Scholar From the Division of Pediatric Urology, Children's Hospital of New Jersey-St. Barnabas Health Care System, Livingston and Section of Urology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey and New York Hospital-Cornell Medical Center, New York, New York© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byCAIN M, RINK R, YERKES E, KAEFER M and CASALE A (2018) Long-Term Followup and Outcome of Continent Catheterizable Vesicostomy Using the Rink ModificationJournal of Urology, VOL. 168, NO. 6, (2583-2585), Online publication date: 1-Dec-2002. Volume 162Issue 3 Part 1September 1999Page: 826-828 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information MONEER K. HANNA More articles by this author FRANK RICHTER More articles by this author JEFFREY A. STOCK More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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