Login to Access Video or Poster Abstract: MP24-11
Sources of Funding: none

Introduction

to present the indications as well as the short and long term results of the Mitrofanoff appendico-vesicostomy (MAV) in children suffering of mild or moderate renal insufficiency.

Methods

Between January 1992 and April 2016, 51 children (27 boys and 24 girls) underwent a Mitrofanoff appendico-vesicostomy as external continent urinary diversion. we exclude at once those presented at end stage renal failure and required renal transplantation. The remaining (45) were aged between 5 and 15 years (mean 10.27); all of them underwent MAV in their right iliac fossa. Etiologies were dominated by neuropathic bladder (41 cases) ,mainly due to spina bifida defect with myelo-meningocele ; a posterior urethral valves causing altered bladder (2 cases) and complicated bladder exstrophy (2 cases). Diagnosis was established at advanced stage in all patients with mild renal failure (11) or moderate renal insufficiency in (34) with mean creatinine clearance of( 41 ml/min/1.73m2).

Results

The average follow-up was approximately 135 months (ranging from 12 to 256 months). All children became continent, 43 (95% ) after a single intervention. Minor complications consisted mainly on difficulties in intermittent catheterization (11.2%), they were treated merely by external stoma refection. The renal function deteriorated to severe renal failure (1 case), 6 years after surgery, then the patient underwent renal transplantation in his left iliac fossa; it remained stable at better levels with no need to dialysis, in 33 cases (average creatinine clearance of 58 ml/min/1.73m2), with mean follow up of 9 years ; it returned to normal (11 cases) .In addition, intermittent self-catheterization was well accepted by all children and their families ,with complete readaptation to daily activities with good quality of life .

Conclusions

The Mitrofanoff appendico-vesicostomy operation is usually associated to good results in children who suffer of some form of renal insufficiency . It ensures better continence status and a satisfactory educational rehabilitation. Our results demonstrate that it could also stabilize damaged renal function for quite a long time before renal replacement programmes if it was associated to mild or moderate renal failure.

Funding

none