The Mitrofanoff principle for urethral failure.

OBJECTIVE

To assess the outcome of surgery for urethral failure.

PATIENTS AND METHODS

Patients undergoing lower urinary tract reconstruction are recorded prospectively by protocol. Thirty-four are presented whose urethra had failed as a conduit; in 23 the urethra was incontinent and in 11 it was spastic causing chronic retention. The incontinent patients had failed a variety of reconstructions, in five including insertion of an artificial sphincter. Those with chronic retention were unable to self-catheterize the urethra.

RESULTS

A continent supra-public diversion using the Mitrofanoff principle was performed. In two patients a new technique was used in which a detrusor tube formed the continent conduit. Ninety-four per cent of patients were continent. Two patients voided to completion, the remainder emptied by self-catheterization. Five minor revisions were required to allow easy catheterization. There was one death. The complication rate was 17%.

CONCLUSION

This type of reconstruction is preferable to the formation of an ileal conduit in this difficult group of patients.