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Continent vesicostomy by cutaneous flap: a good alternative

M. Pons, C. François-Fiquet, D. Chaouadi, M. Belouadah, F. Lefebvre, S. Poret, MA. Bouche-Pillon, G. Lefort, S. Daoud, ML. Poli Merol.

American Memorial Hospital - Reims

 

ABSTRACT

Introduction: Since Mitrofanoff’s description of the principle of the continent transappendicular cystostomy, the treatment for neurologic bladder has improved considerably. The principle of a “conduct” between the skin and the bladder is now perfectly accepted. The appendix not being always available, and the alternative proposed by Monti requiring a peritoneal approach and a digestive anastomosis, we used a tubularized vascular skin flap to fabricate a conduct. The preliminary results made the object of a presentation at a previous congress of the SFCP in 2002, concerning 6 cases. We wish to present the long term results of this technique.

Material and methods: 23 patients were operated on between 1999 and 2008, 16 boys and 7 girls, mean age 13.4 years (18 months – 25 years). All required the installation or the simplification of intermittent catheterisation. The data taken into consideration were: the initial pathology, the presence or absence of associated surgical gestures, the viability of the flap, the complications, the ulterior complementary gestures, the final continence.

Results: We found: concerning the viability of the flap: 1 necrosis of the flap requiring reintervention for Mitrofanoff procedure, 1 loss of flap due to inadequate utilization, 2 “false passage” accidents, 19 good results: regular self-catheterisation, without alteration of the installation; concerning the continence: 2 failures, 5 still presenting leakages through the cystostomy or the native urethra, 16 very good results (70%). We present the technique and discuss our results insisting on the simplicity of the surgical gesture.

 

Key words: vesicostomy, surgical technique, continent cystostomy, skin flap