Iqbal Nadeem, Syed Omar Zia, Bukhari Amna Haider, Sheikh Abdul Ahad Ehsan, Mahmud Umair Syed, Khan Faheemullah, Hussain Ijaz, Akhter Saeed
Department of Urology, Shifa International Hospital, Islamabad, Pakistan.
Shifa College of Medicine, Islamabad, Pakistan.
Turk J Urol. 2018 Nov 26;45(1):42-47. doi: 10.5152/tud.2018.86836. Print 2019 Nov.
Mitrofanoff procedure has been employed commonly as bladder draining tool in patients unable to do clean intermittent self catheterization through native urethera. Single centre experience of pediatric age group patients undergoing Mitrofanoff procedure has been presented here.
It was a retrospective study of 29 children who underwent continent catheterizable conduit (CCC), from January 2009 till March 2017. Charts were reviewed for age, gender, presenting complaints, need for augmentation cystoplasty, Mitrofanoff channel source such as appendix or ileal patch, duration of surgery in minutes, hospital stay in days, per operative and postoperative complications. Preoperative evaluation of the children was done by doing complete blood picture, serum electrolytes, and renal function tests. Radiological evaluation included ultrasound kidney,ureter and bladder, voiding cystourethrography, urodynamic analysis and a nuclear renal scan with 99m Technetium dimercapto-succinic acid or MAG-3 scan. The abdominal end of the conduit was brought through the abdominal wall, and a stoma was fashioned by the V-quadrilateral-Z technique.
Twenty nine children having mean age of 9.54±4.88 years underwent CCC. There were 19 males (65.51%) and 10 females (34.48%). Children who underwent CCC included 18 children having neurogenic bladder, 2 cases of urethral trauma/stricture 3 patients with history of posterior uretheral valve and 6 patients with exstrophy bladder. Augmentation cystoplasty plus mitrofanoff was done in 18 children while only mitrofanoff in 11 children. Stuck catheter was seen in one patient which was removed successfully via normal urethral route under general anesthesia. Stomal stenosis in first year was noted in 4 patients (13.79%).
Continent catheterizable conduit based on Mitrofanoff principle have durable outcome over long term follow up in terms of urinary continence and complications.
米氏术式已被广泛用作无法通过天然尿道进行清洁间歇性自我导尿患者的膀胱引流工具。本文介绍了儿科年龄组患者接受米氏术式的单中心经验。
这是一项对2009年1月至2017年3月期间接受可控性导尿通道（CCC）的29名儿童进行的回顾性研究。查阅病历以了解年龄、性别、主诉、是否需要膀胱扩大术、米氏通道来源（如阑尾或回肠补片）、手术时间（分钟）、住院天数、手术中和术后并发症。对儿童进行术前评估时，进行了全血细胞计数、血清电解质和肾功能检查。影像学评估包括肾脏、输尿管和膀胱超声、排尿性膀胱尿道造影、尿动力学分析以及用99m锝二巯基丁二酸或MAG-3扫描进行的核肾扫描。将通道的腹部末端穿过腹壁，并采用V形四边形-Z技术形成造口。
29名平均年龄为9.54±4.88岁的儿童接受了CCC。其中男性19名（65.51%），女性10名（34.48%）。接受CCC的儿童包括18名神经源性膀胱患儿、2例尿道创伤/狭窄患者、3例有后尿道瓣膜病史的患者和6例膀胱外翻患者。18名儿童同时进行了膀胱扩大术加米氏术式，11名儿童仅进行了米氏术式。1例患者出现导尿管堵塞，在全身麻醉下通过正常尿道途径成功取出。第一年有4例患者（13.79%）出现造口狭窄。
基于米氏原理的可控性导尿通道在长期随访中，在尿失禁和并发症方面具有持久的效果。
