A New Extra-Abdominal Channel Alternative to the Mitrofanoff Principle Based on two Lower Abdominal Cutaneous Flaps: Preliminary Clinical Experience
Purpose The appendix is the gold-standard channel for the Mitrofanoff principle in pediatric urology, but the search for alternatives is justified. The aim of this study is to report on technical feasibility and present our preliminary clinical experience with an alternative conduit based on two lower abdominal skin flaps. Material and Methods We configured a tube from two rectangular skin flaps 1x4 cm opposite each other in the middle line of the lower inferior abdomen. The vascular support of the flaps is based on inferior epigastric and circumflex branches in the subcutaneous tissue. The channel was anastomosed to the bladder dome with embedding 3.0 prolene sutures to create a valvular mechanism. None patients required bladder augmentation and surgery was performed entirely extraperitoneally. We used this method sofar in 4 patients with congenital non-neurogenic bladder diseases presenting with residual volumes without compliance deficits. The last patient was a 16 year old boy and he underwent a laser skin follicules ablation regimen before surgery. Results Mean follow-up of the clinical series is 10.4 months. Three patients remained continent up to 4 hours, whereas 1 patient had urinary leakage through the stoma and underwent open revision of the valve mechanism by crossing the rectus abdominal muscle in the midline to create a neosphincter-shape. Conclusions We were able to confirm feasibility of a new extra-abdominal channel based on the Mitrofanoff. Follow-up is still short but initial experience of a totally extraperitonel method is very appealing sofar.