Early and Long-term outcomes of the use of Mitrofanoff Principle in Management of Urinary Incontinence in a Single Center.

Abstract

Introduction: The management of urinary incontinence can be a challenge to the urologist. Since its description in 1980, the Mitrofanoff principle and its modifications has provided a means of achieving a catheterized continent urinary diversion in well selected patients. The indications for the use of an appendicovesicostomy for urinary diversion varies from congenital to acquired anatomical and functional urinary tract dysfunctions. When utilized, it provides a continent low-pressure reservoir with minimal risk of recurrent urinary tract infections or calculus formation and an improved quality of life. Stomal stenosis, false passages, reoccurrence of the incontinence are some of the reason why the appendicovesicostomy may be revised. We hereby present the early and late outcomes of our patients managed with a Mitrofanoff for urinary incontinence. Methods: We retrospectively reviewed the medical records of all patients managed for urinary incontinence by the unit from January 2009- December 2019. Only patients managed with a Mitrofan off were included in this study. Data on the age at presentation, previous attempt at surgery, etiology, bladder capacity at diagnosis, ancillary procedures such as bladder augmentation, Site of stoma, complications and duration of follow up were collected. Data was analyzed using SPSS version 20. Results: A total of 5 Mitroffanoff was done during the study period. Male: female ratio of 4:1. The age range at presentation was 9-29years with a median of 19years old. Neurogenic bladder from Spinal dysraphism and bladder exstrophy as the etiology in two patients respectively and a patient had the procedure due to spinal cord injury. The two patients with exstrophy had additional procedure which were augmentation cystoplasty and cystolithotomy respectively. All had a stoma located at the umbilicus except one of the exstrophy patient who had a stoma in right iliac fossa. Stomal stenosis was the commonest complication seen in 4 of the patients leading to revision of the stoma. Other complications noted was urosepsis and stomal prolapse noted in one fifth of the patient respectively. The quality of life in these patients has been satisfactory with pregnancy and delivery recorded in one of the female patients. Follow up range from 1 -13years with a median of 8years. Conclusion: Mitrofanoff is a reasonable modality for the management of neurogenic bladder in well selected patients with good quality of life noted. Stomal stenosis is the commonest complication usually leading to revision of the procedure.