title: Bladder augmentation in anuric/defunctioned microbladders and a novel antireflux mechanism for Mitrofanoff anastomosis to the ileal patch.
abstract: OBJECTIVE
  Reconstruction of microbladders is a difficult surgical challenge: How can a neobladder be recreated when >90% of the new bladder is augmented patch, and how can a Mitrofanoff conduit be anastomosed when the native bladder is so tiny? This series describes microbladders secondary to anuria and/or diversion that required augmentation. This was done using a de-tubularized ileal segment, and because of the small size of the native bladder, Mitrofanoff anastomosis was performed to the bowel patch (using a novel "Keel Procedure").
  
  
  METHODS
  Our surgical experience in reconstruction of microbladders was reviewed: pre and post augmentation capacity, compliance and maximum detrusor pressure were compared. The success of the Mitrofanoff anti-reflux technique is described. Data are given as median (interquartile range) and compared by Wilcoxon paired rank test.
  
  
  RESULTS
  10 patients, median bladder capacity pre-op 10 (9-20) mls were reconstructed. The follow up time is 2.7years (2.2-4.2). Post-op bladder capacity increased 16-fold to 167 (114-281) mls, P<0.01. Compliance significantly improved from 1.7 (0.3-4.8) to 14.3 (4.1-66.3) mls/cmH2O, P<0.05. Maximum detrusor over-activity decreased from 27 (7-120) to 12.5 (8-26) cmH2O, (N.S. P=0.3). Videourodynamics confirmed a leak in 2 patients, leading to incorporation into the technique of a non-absorbable seromuscular suture to provide long-term robustness to the antireflux procedure.
  
  
  CONCLUSIONS
  Bladder augmentation in microbladders is possible, and a functional Mitrofanoff procedure with a continent anti-reflux procedure can be created using the "Birmingham keel technique" implanting the Mitrofanoff into the augment patch, with 80% success (similar to published results for conventional anastomosis to native bladders).
  
  
  METHODS
  Level IV.
authors.affiliation: Birmingham Children's Hospital, Department of Paediatric Surgery and Urology, Birmingham, UK.
authors.forename: Joana
authors.initials: J
authors.lastname: Lopes
authors.affiliation: Birmingham Children's Hospital, Department of Paediatric Surgery and Urology, Birmingham, UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Robb
authors.affiliation: Birmingham Children's Hospital, Department of Paediatric Surgery and Urology, Birmingham, UK. Electronic address: liam.mccarthy@bch.nhs.uk.
authors.forename: Liam
authors.initials: L
authors.lastname: McCarthy
mesh_terms: D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000002:abnormalities* / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000151:congenital / Q000601:surgery*; D014564:Urogenital Abnormalities / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Antireflux; Augmentation; Ileocystoplasty; Microbladder; Mitrofanoff; Monti