title: An alternative channel for the Mitrofanoff principle based on transverse skin flaps: an extraperitoneal minimal invasive approach (the RPM technique).
abstract: OBJECTIVE
  The Mitrofanoff principle is a well established strategy in pediatric urology, with the appendix and Yang-Monti tube being the most used channels. The search for an alternative tube with less morbidity is justified. Hence, we present a patient treated via an alternative approach in which the channel was constructed from two lower abdominal transverse skin flaps (the RPM technique).
  
  
  METHODS
  A 17-year-old patient with posterior urethral valves, hypocontractile bladder and experiencing pain on urethral clean intermittent catheterization was selected. The procedure consisted of defining two rectangular transverse skin flaps of 5 × 1 cm opposite to each other. The flaps were rotated 90° and anastomosed to create a tube. A small extraperitoneal bladder wall incision was performed and the tube was connected to the bladder. Two rectal abdomen muscle strips were crossed in the midline as a neosphincter.
  
  
  RESULTS
  The patient had an uneventful postoperative course and remains continent for intervals of 4 h. The stoma and incision have a good cosmetic aspect at 16 months follow-up.
  
  
  CONCLUSIONS
  The RPM technique is an alternative approach for a minimal invasive strategy according to the Mitrofanoff principle. Long-term follow-up is necessary to confirm the excellent initial results.
authors.affiliation: Federal University of São Paulo, Rua Maestro Cardim, 560 cj 215, 01323 000 São Paulo - SP, Brazil. macedojr@usp.br
authors.forename: Antonio
authors.initials: A
authors.lastname: Macedo
authors.forename: Atila
authors.initials: A
authors.lastname: Rondon
authors.forename: Herick
authors.initials: H
authors.lastname: Bacelar
authors.forename: Bruno
authors.initials: B
authors.lastname: Leslie
authors.forename: Sérgio
authors.initials: S
authors.lastname: Ottoni
authors.forename: Riberto
authors.initials: R
authors.lastname: Liguori
authors.forename: Gilmar
authors.initials: G
authors.lastname: Garrone
authors.forename: Valdemar
authors.initials: V
authors.lastname: Ortiz
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D001065:Appendix / Q000601:surgery; D003559:Cystostomy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D010537:Peritoneum / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps; D016896:Treatment Outcome; D014521:Urethra / Q000002:abnormalities / Q000601:surgery; D001743:Urinary Bladder / Q000002:abnormalities / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods; D016476:Urinary Reservoirs, Continent; D014564:Urogenital Abnormalities / Q000175:diagnosis / Q000601:surgery*