The Mitrofanoff principle is a well established strategy in pediatric urology, with the appendix and Yang-Monti tube being the most used channels. The search for an alternative tube with less morbidity is justified. Hence, we present a patient treated via an alternative approach in which the channel was constructed from two lower abdominal transverse skin flaps (the RPM technique).
A 17-year-old patient with posterior urethral valves, hypocontractile bladder and experiencing pain on urethral clean intermittent catheterization was selected. The procedure consisted of defining two rectangular transverse skin flaps of 5 × 1 cm opposite to each other. The flaps were rotated 90° and anastomosed to create a tube. A small extraperitoneal bladder wall incision was performed and the tube was connected to the bladder. Two rectal abdomen muscle strips were crossed in the midline as a neosphincter.
The patient had an uneventful postoperative course and remains continent for intervals of 4 h. The stoma and incision have a good cosmetic aspect at 16 months follow-up.
The RPM technique is an alternative approach for a minimal invasive strategy according to the Mitrofanoff principle. Long-term follow-up is necessary to confirm the excellent initial results.
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Published online: March 26, 2012
Accepted: February 6, 2012
Received: December 22, 2011
☆The full article and Supplementary video relating to this article can be found at doi:10.1016/j.jpurol.2012.02.003, and www.jpurol.com
© 2012 Journal of Pediatric Urology Company. Published by Elsevier Inc. All rights reserved.
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- Re: Macedo A Jr, Rondon A, Bacelar H, Leslie B, Ottoni S, Liguori R et al. An alternative channel for the Mitrofanoff principle based on transverse skin flaps: An extraperitoneal minimal invasive approach (the RPM technique). J Pediatr Urol 2012;8:437.Journal of Pediatric UrologyVol. 8Issue 5
- PreviewWe congratulate the authors for evolving this innovative technique of skin-based flap for cutaneous diversion with continence based on crossing strips of rectus abdominis muscle. Our concern is that while the bowel is usually insensitive to touch, thermal or traumatic stimuli and is only sensitive to stretch , the same phenomenon may not apply to a skin-flap-based tube. The skin-based continent catheterizable stoma might be painful on repeated self-catheterization, which reduces the compliance of the patient, especially in the case of children on long-term follow up.