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CONGRESS OF THE ESPU
17:07–17:10
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CONTINENT CUTANEOUS OUTLET IN CHILDREN:
TIME TO EVENT ANALYSIS
Tamer HELMY
1
, Helmy OMAR
2
, Hesham ORBAN
2
, Ahmed GALAL
2
,
Mohammed DAWABA
2
and Ashraf HAFEZ
2
1) Urology & Nephrology center Mansoura, Paediatric Urology, El Mansoura, EGYPT - 2) Urology and Nephrology
Center, Paediatric Urology, Mansoura, EGYPT
PURPOSE
We retrospectively analyzed the outcomes of continent urinary diversion in children who were suf-
fering from irreversible lower urinary tract dysfunction.
MATERIAL AND METHODS
The study included 182 children (109 boys and 73 girls) who underwent continent urinary diversion
between May 1993 and May 2015. The procedure was carried out in 88 patients with extrophy,
79 with neuropathic bladder and 15 cases with other rare indications. Appendix was used as outlet
in 122 patients and ileum in 60 patients. Patients were followed up to evaluate continence status
and post operative complications. Continence is defined as staying dry for at least 3 hours.
RESULTS
Of 154 evaluable patients, mean age at time of surgery was 7.9+3.8 years. Mean follow up was 78 +
58 months. Urinary leakage via the stoma has been reported in 31 patients (20.1%). Mitrofanoff
outlet is associated with higher continence rate (p=0.05). Late complication had been reported in
57 patients (37%) including pouch stones in 27 patients, stomal stenosis in 19 children and failed
catheterization in 4 while prolapsed stoma occurred in 3 children. parastomal hernia, pouch perfora-
tion, poucho-colonic fistula and Monti fistula each reported in one patient. Stomal complications
were relatively higher with Monti outlet especially stomal revision (p= 0.002).
CONCLUSIONS
Continent cutaneous outlet is versatile surgical technique suitable for urinary diversion in children.
In our study, Mitrofanoff outlet is associated with higher continence rate and lower complications
than Monti outlet.
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★
THE DOUBLE UMBILICAL STOMA FOR COMBINED
MITROFANOFF AND MALONE PROCEDURE
Gregory DEAN
1
, Matthew SCHAFF
2
, Jonathan ROTH
1
and Michael PACKER
1
1) Temple University, Urology, Philadelphia, USA - 2) Temple University, Philadelphia, USA
PURPOSE
The advent of the Mitrofanoff procedure has advanced the care of children with the need for intermit-
tent catheterization. Many of these children can also benefit from performing a Malone procedure for
bowel management. The split appendix technique has permitted many of these children to undergo
both of these procedures using only the appendix. In a quest to maximize cosmetic outcome, we
prefer to perform this split technique with placement of both stomas within the umbilicus. In this film
we demonstrate this technique.