Mitrofanov’s principle in the practice of pediatric urologist

Abstract

Introduction. Management of neurogenic bladder is quite serious problem in child urologist practice. The key place for improvement quality of life is choice adequate way to restore the reservoir and evacuation function of the bladder. Treatment tactics of urinary incontinence is significantly changed by principle of Mitroffanof. Positive results are observed in 90% cases. Objective: Improving the tactics of treatment at children with severe urological pathology and show the benefits of the Mitroffanof principle. Materials and methods: We made retrospective analyze of six cases procedure Mitroffanof in our clinic from 2010 to 2020 years. Mitroffanof’s procedure was performed on patients with the following pathologies: neurogenic bladder dysfunction, bladder exstrophy, total epispadias of the penis with bladder neck insufficiency and in one case multiple genius defects with anorectal malformation. Results: Аppendix was the source of conduit in all cases. Appendix entered to belly button in one case and in other cases appendix entered to right iliac region. The cosmetic result was better in the stoma brought to the navel. Bladder part of stoma implanted with anti - reflux mechanism in posterior wall of bladder in all cases. The cutaneous part of the appendicostomy is formed by VQ - flap plastics in 5 cases, in one case formed by U- plastic. We had two complications. First is stenosis of cutaneous part of stoma, second was formed of erroneous pass in cutaneous part of stoma. Conclusions: Mitroffanof principle becomes a good alternative way of derivation urine from bladder in patients with heavy urological pathology and improve their quality of life. Although complications are quite common in patients with appendicostomy, most of them can be corrected conservatively, endoscopically or surgically.