Abstract
Objective
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).
Methods
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.
Results
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.
Conclusion
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.
Keywords
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References
- Trans-appendicular continent cystostomy in the management of the neurogenic bladder.Chir Pediatr. 1980; 21: 297
- New techniques for construction of efferent conduits based on the Mitrofanoff principle.Urology. 1997; 49: 112
- A continent catheterizable ileum-based reservoir.BJU Int. 2000; 85: 160
- A new extra-abdominal channel alternative to the Mitrofanoff principle: experimental and preliminary clinical experience.Int Braz J Urol. 2009; 35: 205
- Use of cutaneous flap for continent cystostomy (daoud technique).J Urol. 2010; 184: 1116
Article info
Publication history
Published online: March 26, 2012
Accepted:
February 6,
2012
Received:
December 22,
2011
Footnotes
☆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
Identification
Copyright
© 2012 Journal of Pediatric Urology Company. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- 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 [1], 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.
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