The Mitrofanoff principle. Technique and application in continent urinary diversion.

The Mitrofanoff procedure (appendicovesicostomy and creation of a low-pressure urinary reservoir) is a technically innovative way of providing patients with a form of continent diversion. The principles behind the procedure are use of a narrow, supple conduit, which, when brought out to the skin as a catheterizable stoma, will provide continence by acting as a flap-valve and attachment of the conduit to a low-pressure urine storage reservoir by an antireflux mechanism. Upper-tract contamination is prevented by an antireflux mechanism at the level of the distal ureters. Strict attention to every step of the procedure is mandatory. Emptying of the reservoir is achieved by clean intermittent catheterization. Long-term results are good in a majority of patients with careful selection and education. Life-long follow-up of patients is mandatory.