OBJECTIVE: to study the efficacy and safety of using appendix as catheterizable conduit based on Mitrofanoff procedure in urinary diversion.
METHODOLOGY: This prospective observational study was conducted at department of surgery, Hayatabad medical complex and Khyber teaching hospital from 1st January 2005 till 31st December 2011. Total number of 56 patients (38 males and 18 females) from 5-60 years of age were included in the study. Mitrofanoff principle was used to achieve clean intermittent catheterization and urinary continence. Patients were followed for two years with, initially 3 months and then 6 months intervals. All the data was collected on structured proforma and was analyzed on SPSS.
RESULTS: Out of 56 total patient, primary diagnosis was transitional cell carcinoma in 23 (41%) case, exstrophy-epispadias in 10(17.9%), urethral injury in 7(12.5%) cases and miscellaneous in 16 (28.5%) cases. Augmentation cystoplasty was performed in 9 (16%) and 33(58.9%) patients had neobladder formation in conjunction with Mitrofanoff procedure. Urinary continence was achieved in 51(91%) patients. Mortality rate was 3.5% (n=2/56) and 3(5.3%) patients were lost to follow up. Complications were observed in 18 (35.2%) cases. Stomal stenosis was most common complication in 7(12.5%) patients, followed by incisional hernia, wound infection, suprapubic fistula and intestinal obstruction in 2 (3.9%) patients each. Only 7 (13.7%) needed surgical management, rest of 11(21.5%) were treated conservatively.
CONCLUSION: Mitrofanoff procedure provides immense advantage to patients needing urinary diversion, as it is associated with far less complications, higher continence rate and greatly improved level of independence in bladder management.
KEY WORDS: Radical cystectomy, Urinary diversion, Mitrofanoff principle.
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