Continent Urinary Diversion with Short Appendices in Obese Patients: the Initial Results of a Surgical Option

Abstract

Introduction: Many patients need to be submitted to a continent urinary derivation surgery. Lost of bladder compliance secundary to neurogenic bladder injuries, severe and untractable urethral stenos is are some of the main indications. We present here the initial results and outcomes of twelve procedures performed using the association between Mitrofanoff's principle and Monti's technique as a surgical option for a continenturinarydiversion in patients with short appendices or obese. Materials and Methods: We analyzed data from twelve patients who were submitted to ileocistoplasty and urinary continent derivation by association between Mitrofanoff's principle and Monti's technique performed from january2009 to december 2012 in our institution. In all patients the appendices were too short to reach the skin, some of them, because the obesity. Results: Twelve patients were submitted to the Mitrofanoff and Monti techniques association. The most common surgical complications were stoma skin stenosis (02 cases) and urinary leakage through the reopened bladder neck in 02 patients. Urinary infection (01 sepse) was the main clinical complication. Eleven patients are totally adapted to intermittent clear catheterization through the naveland satisfyed with urinary continence and quality of life.There were no deaths and no urinary or intestinal fistulas secondary to the procedure. Conclusions: The association between Mitrofanoff's principle and Monti's technique is safe, feasible and a very useful alternative in urologic cases, (i.e., severe and untractable urethral stenos is and low compliance neurogenic bladder, for example) of continent urinary diversion, when the ileocecal appendix is too short to reach the skin (i.e., obese patients).