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Urinary Diversion
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Véronique Phé, Gilles Karsenty
Three general principles have been described7: Intussuscepted nipple valve (Kock, Benchekroun, Mainz III without appendix pouch) bearing a risk of nipple destabilization despite the most experienced surgeons.13,14Tapered or imbricated, or both, terminal ileum used in right colon pouches (Indiana [Figure 33.8], Florida Mainz II) with the ileocecal valve as a ready-made continence mechanism.13,15–17.Efferent appendicular or pseudo-appendicular tubes are based on a technical principle described by Mitrofanoff in 1980 (Figures 33.10 through 33.12), using the appendix or ureter to create a flap valve, and at the same time a neourethral conduit to the bladder18,19 (Figure 33.9) (see details in Chapter 34). When appendix is not available, a detubularized and remodeled ileal segment (Monti, Casale) can be built. The Mitrofanoff principle can be used as well in the native bladder (augmented or not) as in any type of intestinal pouch.13 The Mitrofanoff principle is the most commonly used CUD technique in neuro-urology.20
Invasive bladder cancer and urinary diversion
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Catheterizable stoma: Mitrofanoff principle uses appendix flap valve. Can also use tapered ileal segment implanted into colon tinea or serosal lined rough. Monti is a short detubularized ileal segment rolled into a tube.
Urinary diversion
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Sender Herschorn, Greg G. Bailly
The appendix has many advantages over other methods for creating a continent catheterizable stoma.55 The intraluminal pressure can rise nearly threefold that of the reservoir itself.56 Perhaps, the most important aspect of the flap-valve mechanism is the tunnel length to lumen ratio. Urodynamic evaluation has shown that a minimal tunnel length of 2 cm is required to achieve continence.57 The Mitrofanoff principle can be used on native bladder, enterocystoplasty, or in a continent urinary reservoir. Because it is so reliable in preventing incontinence, it may place the patient at risk for upper tract deterioration or spontaneous rupture of the bladder or reservoir if regular catheterization is not performed. The appendix is particularly well suited for children because it is relatively longer and the abdominal wall is thinner. It also circumvents many of the secondary complications associated with using the ileocecal valve or other bowel segments. One possible disadvantage is with occurrence of bladder stones, simple endoscopic cystolitholapaxy may not be possible because of the narrow lumen. Other procedures such as percutaneous cystoscopy, laparoscopic, or open surgery may be required.
Pharmacological treatments available for the management of underactive bladder in neurological conditions
Published in Expert Review of Clinical Pharmacology, 2018
Seyedeh-Sanam Ladi-Seyedian, Behnam Nabavizadeh, Lida Sharifi-Rad, Abdol-Mohammad Kajbafzadeh
The Mitrofanoff principle is useful for UAB patients who cannot perform CIC through the urethra as well as children with urinary and fecal incontinence. This method could protect the renal function and improve patients’ quality of life [6,129]. It has been demonstrated that the procedure can eliminate the need for transurethral self-catheterization and results in better school performance, adherence to therapy, and less complications in children [130,131].