Appendicovesicostomy: the mitrofanoff procedure-a 15-year perspective.
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.
Harris
C F
CF
Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Cooper
C S
CS
Hutcheson
J C
JC
Snyder
H M
HM
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*