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Is continent diversion using the Mitrofanoff principle a viable long-term option for adults requiring bladder replacement?
SAHADEVAN Kanagasabai ; PICKARD Robert S. ; NEAL David E. ; ...
OBJECTIVE To audit the long-term outcome of patients with Mitrofanoff continent urinary diversion (MUD) to inform counselling of future patients concerning the procedure. PATIENTS AND METHODS All patients who underwent MUD between 1990 and 2003 were identified. Continence, urinary tract infection (UTI), calculus formation and renal function were assessed by chart review and interviews. RESULTS Of the 29 patients identified 12 were women and 17 men with a mean (range) age of 48 (18-79) years at operation. The median (range) follow-up was 126 (5-190) months. On questioning, 25 of 28 (89%) patients stated that they were continent. There was more than one confirmed UTI per year in two patients. Half of the patients had at least two UTls within the follow-up period but with no deterioration in renal function. Calculi developed in eight (29%) patients; four with bladder, three with renal and one with both renal and bladder calculi. Stomal stenosis developed in 15 (54%) patients requiring intervention at a mean (range) rate of 0.4 (0.1-2.4) episodes per year and nine ultimately required stomal reconstruction. Five (18%) patients required conversion to ileal conduit, two of these for persistent incontinence and three for recurrent stomal complications, at a mean (range) of 82 (9-140) months. CONCLUSIONS MUD is effective in offering continence with no major deterioration of renal function; however, this needs to be balanced against the need for subsequent additional interventions for
PMID : 18279448 ISSN : 1464-4096
BJU international (Papier) A. 2008, vol. 102, n° 2, pp. 236-240 [5 pages] [bibl. : 27 ref.]
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