Factors That Influence Outcomes Of The Mitrofanoff And Malone Antegrade Continence Enema Reconstructive Procedures In Children

摘要

No AccessJournal of UrologyPEDIATRIC UROLOGY1 Oct 2002Factors That Influence Outcomes Of The Mitrofanoff And Malone Antegrade Continence Enema Reconstructive Procedures In Children Travis Clark, John C. Pope, Mark C. Adams, Nancy Wells, and John W. Brock Travis ClarkTravis Clark More articles by this author , John C. PopeJohn C. Pope More articles by this author , Mark C. AdamsMark C. Adams More articles by this author , Nancy WellsNancy Wells More articles by this author , and John W. BrockJohn W. Brock More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64515-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Surgical techniques that provide adequate urinary and fecal continence in children with neurogenic bladder and bowel dysfunction are becoming increasingly used. We reviewed our experience and discuss factors that influence outcome. Materials and Methods: Between 1994 and 2000, 65 stomal procedures were performed in 47 patients. For the urinary continent catheterizable channel we used appendix in 60% of cases, a continent bladder tube in 20%, a Yang-Monti tube in 16% and ureter in 4%. For the antegrade continence enema continent catheterizable channel we used appendix in 85% of cases, a Yang-Monti tube in 5% and a cecal tube in 10%. In the 19 patients who underwent simultaneous Mitrofanoff and antegrade continence enema procedures the urinary continent catheterizable channel was appendix in 21%, a Yang-Monti tube in 32% and continent vesicostomy in 47%. Patients were divided into 2 groups based on compliance status. In addition, percentile body weight for age was evaluated. Results: Stomal continence was achieved in 63 of the 65 cases (97%). Of the patients who underwent the antegrade continence enema procedure 95% achieved continence via the rectum. Except for ureter stenosis rates according to continent catheterizable channel type did not differ greatly, namely 19% for appendix, 11% for the Yang-Monti tube, 22% for the bladder tube, 50% for ureter and 0% for the cecal tube. Infectious complications developed in 16 patients and 4 had stones. The rates of infection (p = 0.004), stomal stenosis (p = 0.001) and revision (p = 0.004) were statistically lower in the compliant group and the stone formation rate showed a trend favoring the compliant group (p = 0.11). No significant difference was noted for incontinence. Percentile weight predicted a higher rate of stomal stenosis with the highest rate of stomal stenosis overall in the greater than 100th percentile group. Conclusions: The Mitrofanoff and antegrade continence enema procedures are reliable and effective. Proper patient selection and surgical technique with a tension-free anastomosis are essential. The choice of tissue for constructing the continent catheterizable channel is not as important as patient compliance, age and possibly body habitus. This report reinforces the importance of careful screening, and rigorous preoperative and postoperative teaching to achieve overall patient success. References 1 : Cystostomie continent trans-appendiculaire dans le traitement des vessies neurologiques. Chir Pediatr1980; 21: 297. Medline, Google Scholar 2 : Preliminary report: the antegrade continence enema. Lancet1990; 336: 1217. Crossref, Medline, Google Scholar 3 : Yang needle tunneling technique in creating antireflux and continent mechanisms. J Urol1993; 150: 830. Link, Google Scholar 4 : New techniques for construction of efferent conduits based on the Mitrofanoff principle. Urology1997; 49: 112. Crossref, Medline, Google Scholar 5 : Clinical applications of the Monti procedure as a continent catheterizable stoma. Urology1999; 54: 152. Crossref, Medline, Google Scholar 6 Casale A. J. Continent vesicostomy: a new method utilizing only bladder tissue. Presented at 60th annual meeting of American Academy of Pediatrics, New Orleans, Louisi