title: Mitrofanoff for valve bladder syndrome: effect on urinary tract and renal function.
abstract: OBJECTIVE
  Despite early diagnosis and valve ablation, progressive renal impairment develops in a significant proportion of boys born with posterior urethral valves. Bladder dysfunction is thought to have an important role in the etiology of this renal deterioration. We report the outcome of treating bladder dysfunction with clean intermittent catheterization and overnight drainage via a Mitrofanoff appendicovesicostomy with respect to upper tract imaging, urodynamic findings and renal function.
  
  
  METHODS
  All patients were established on a clean intermittent catheterization program via the Mitrofanoff stoma, including 3 or 4 daytime catheterizations and overnight drainage with an indwelling catheter. We analyzed trends in serum creatinine, renal ultrasound appearance and urodynamic data.
  
  
  RESULTS
  Mitrofanoff formation was performed in 24 patients with valve bladder syndrome. Median followup was 6.2 years. Hydronephrosis, quantified by combined anteroposterior diameter measurements of the renal pelvis, significantly improved with a mean combined anteroposterior diameter reduction of 14.2 mm (95% CI 7.6-20.9, p ≤ 0.001). Overall bladder dysfunction improved. Capacity was decreased in 9 of 12 patients (75%) initially compared with 12 of 21 (57%) after Mitrofanoff surgery (p = 0.457). Compliance was poor in 75% of patients initially vs 28.6% at followup (p = 0.014). Despite improvements in hydronephrosis and urodynamic parameters the mean estimated glomerular filtration rate deteriorated. End stage renal failure developed in 35% of cases during followup.
  
  
  CONCLUSIONS
  Treatment of valve bladder with clean intermittent catheterization and overnight drainage via a Mitrofanoff stoma can achieve significant improvements in hydronephrosis and bladder dysfunction urodynamic parameters. However, it does not prevent renal deterioration.
authors.affiliation: Birmingham Children's Hospital, National Health Service Foundation Trust, Birmingham, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: King
authors.affiliation: Birmingham Children's Hospital, National Health Service Foundation Trust, Birmingham, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Coleman
authors.affiliation: Birmingham Children's Hospital, National Health Service Foundation Trust, Birmingham, United Kingdom.
authors.forename: Karan
authors.initials: K
authors.lastname: Parashar
mesh_terms: D002408:Catheters, Indwelling; D002648:Child; D003404:Creatinine / Q000097:blood; D003559:Cystostomy; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D015999:Multivariate Analysis; D010349:Patient Compliance; D051437:Renal Insufficiency / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas; D013577:Syndrome; D014463:Ultrasonography; D014521:Urethra / Q000002:abnormalities*; D014546:Urinary Catheterization; D014563:Urodynamics; D013520:Urologic Surgical Procedures
chemical_list: D003404:Creatinine
keywords: abnormalities; catheterization; chronic; patient compliance; renal insufficiency; urinary bladder