The Mitrofanoff principle for urethral failure.
OBJECTIVE
To assess the outcome of surgery for urethral failure.


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%.


CONCLUSIONS
This type of reconstruction is preferable to the formation of an ileal conduit in this difficult group of patients.
Woodhouse
C R
CR
Department of Urology, St George's Hospital, London, UK.
Gordon
E M
EM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003559:Cystostomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014522:Urethral Diseases / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000601:surgery; D016055:Urinary Retention / Q000601:surgery; D014572:Urology / Q000379:methods