Bladder continent catheterizable conduit (the Mitrofanoff procedure): Long-term issues that should not be underestimated

Background: Effective bladder emptying by clean intermittent catheterization for children with severe bladder dysfunction is critical for renal preservation and social integration. Use of a continent catheterizable conduit (CCC) as urethral alternative procedure provides effective bladder drainage. However, it brings a substantive maintenance. Methods: Retrospective review of the indications and long-term outcomes of 54 patients with a Mitrofanoff procedure in a single center over a 20-year period (1995-2015). Results: Indications of CCC include 21 neurogenic bladders, 12 patients with epispadias/exstrophy, 13 bladder outlet obstruction, 6 malignancies and 2 cloaca. Median age at surgery was 8.3 years (4 months-20 years). The appendix was used in 76% of cases. Most frequently encountered complication was stomal stenosis (n = 17/34, 50%), occurring at median time of 9 months (2 months-13 years). The other complications were: leakage in 9 (26.5%); conduit stricture in 5 (14.7%), angulation of the conduit in 2 (5.8%) and prolapse in one (3%). Operative revision was encountered by 33 (61%) patients, the majority in the first 2 years. Median follow-up was 4.3 years (3 months-16 years). Conclusions: CCC has a high incidence of complication. It has to be used only when the native urethra is not suitable for catheterization. Carers, patients and families must be prepared to deal with both the complexity of index conditions and the complications of this procedure. (C) 2017 Published by Elsevier Inc.