title: Bladder continent catheterizable conduit (the Mitrofanoff procedure): Long-term issues that should not be underestimated.
abstract: BACKGROUND
  Effective bladder emptying by clean intermittent catheterization for children with severe bladder dysfunction is critical for renal preservation and social integration. Use of a continent catheterizable conduit (CCC) as urethral alternative procedure provides effective bladder drainage. However, it brings a substantive maintenance.
  
  
  METHODS
  Retrospective review of the indications and long-term outcomes of 54 patients with a Mitrofanoff procedure in a single center over a 20-year period (1995-2015).
  
  
  RESULTS
  Indications of CCC include 21 neurogenic bladders, 12 patients with epispadias/exstrophy, 13 bladder outlet obstruction, 6 malignancies and 2 cloaca. Median age at surgery was 8.3years (4months-20years). The appendix was used in 76% of cases. Most frequently encountered complication was stomal stenosis (n=17/34, 50%), occurring at median time of 9months (2months-13years). The other complications were: leakage in 9 (26.5%); conduit stricture in 5 (14.7%), angulation of the conduit in 2 (5.8%) and prolapse in one (3%). Operative revision was encountered by 33 (61%) patients, the majority in the first 2years. Median follow-up was 4.3years (3months-16years).
  
  
  CONCLUSIONS
  CCC has a high incidence of complication. It has to be used only when the native urethra is not suitable for catheterization. Carers, patients and families must be prepared to deal with both the complexity of index conditions and the complications of this procedure.
authors.affiliation: Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia. Electronic address: alice.faure@ap-hm.fr.
authors.forename: Alice
authors.initials: A
authors.lastname: Faure
authors.affiliation: Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cooksey
authors.affiliation: Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia.
authors.forename: Aurore
authors.initials: A
authors.lastname: Bouty
authors.affiliation: Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Woodward
authors.affiliation: Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia; FD Stephens Surgical Research Group, Murdoch Childrens Research Institute, Department of Paediatric Urology, Melbourne, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Hutson
authors.affiliation: Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia.
authors.forename: Mike
authors.initials: M
authors.lastname: O'Brien
authors.affiliation: Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia.
authors.forename: Yves
authors.initials: Y
authors.lastname: Heloury
mesh_terms: D000293:Adolescent; D001065:Appendix / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004842:Epispadias / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D014546:Urinary Catheterization / Q000379:methods*; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects; D055815:Young Adult
keywords: Continent catheterizable conduit; Mitrofanoff; Urology