Mitrofanoff式膀胱闌尾小便造口術尿路分流 -- 高雄長庚四案例分析
林士勛，江博暉1
高雄長庚紀念醫院外科部 泌尿科1
Urinary diversion with Mitrofanoff appendicovesicostomy reconstruction
:4 cases KCGMH experience sharing
Shih-Hsun Lin，Po-Hui Chiang
Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Purpose: Trans-appendicular continent cystostomy was first described by Paul Mitrofanoff in 1980. The method was used with appendix to create a continent conduit between bladder and skin. The indication of the Mitrofanoff procedure included the neuropathic bladder (conduit into the native or augmented bladder), urethral strictures, urethral injuries, and significant bladder dysfunction associated with an intact urethral sensation. Here, we described our experience with four cases of adult male patients with the use of Mitrofanoff appendicovesicostomy reconstruction.
Material and methods: We performed a retrospective review of all patients at our institution who underwent appendicovesicostomy from May 2011 to May 2015. Appendicovesicostomy was performed in 4 male adult patients and all of them were performed by one surgeon (P-H Chiang). Indication for surgery was either severe urethra injury status post several times OIU (3 cases) or penile cancer status post total urethrectomy and prostatectomy after recurrence of total penectomy at local hospital (1 case). The appendicovesicostomy was carried out by Mitrofanoff procedure and the stomas were all created over right lower quadrant.
Results: Mean age was 38.8 years old and mean BMI was 25.3. Overall mean operation time was 289 minutes (range 195 to 459) and mean EBL was 25 cc (range 20 to 30). There was no major complication during operation. Median length of stay (LOS) were 21.5 days (range 18 to 23). Median follow up was 19.8 months (range 9 to 41). None of them sustained urinary incontinence. One patient required revision of the stoma 4 months later after appendicovesicostomy secondary to skin fibrosis with scar contracture. Two patients are currently catheterizing (2-3times/day) without difficulty. All patients remain normal kidney function as before operation.
Conclusions: The appendicovesicostomy is an effective and safe way to provide a continent conduit for bladder catheterization despite adult or children. To our knowledge, this might be the first case to perform appendicovesicostomy in patient who suffered from total penectomy and prostatectomy due to penile cancer. Thus, we provided a novel surgical method for patients who do not need Foley catheter indwelling by creating a continence appendicovesicostomy.