title: Appendicovesicostomy: the mitrofanoff procedure-a 15-year perspective.
abstract: OBJECTIVE
  Appendicovesicostomy was introduced in the United States in 1982 at our hospital. It has become the most popular alternate continence channel for catheterization. We reviewed the experience of 1 surgeon with appendicovesicostomy during a 15-year period.
  
  
  METHODS
  We retrospectively reviewed the operative reports and clinical records of 50 consecutive patients in whom appendicovesicostomy was performed by 1 surgeon between 1982 and 1998. The underlying diagnosis was myelomeningocele in 31 cases, bladder exstrophy in 6, the prune-belly syndrome in 2, posterior urethral valves in 2 and other disorders in 10. Mean patient age at surgery was 13.1 years (range 4 months to 25 years) and mean followup was 4.3 years (range 3 months to 16.3 years).
  
  
  RESULTS
  Of the 50 patients 96% continue to catheterize the appendicovesicostomy. Stomal stenosis developed in 5 cases (10%) and other complications included stricture and appendiceal perforation in 2 each. Eight patients (16%) required appendicovesicostomy revision at a median of 7.3 months (range 1 month to 5.8 years) after the initial procedure. Median time to revision for stomal stenosis was 13 months (range 1 month to 5.8 years). Appendicovesicostomy continence was achieved in 49 patients (98%).
  
  
  CONCLUSIONS
  Our series demonstrates the successful long-term outcome and durability of appendicovesicostomy in children. Careful adherence to technique at initial surgery helps ensure a high long-term success rate.
authors.affiliation: Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: Harris
authors.forename: C S
authors.initials: CS
authors.lastname: Cooper
authors.forename: J C
authors.initials: JC
authors.lastname: Hutcheson
authors.forename: H M
authors.initials: HM
authors.lastname: Snyder
mesh_terms: D000293:Adolescent; D000328:Adult; D001065:Appendix / Q000601:surgery*; D001746:Bladder Exstrophy / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000150:complications; D011183:Postoperative Complications; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery*