The Choice of Suprapubic Continent Catheterisable Urinary Stoma

Abstract

Two types of continent urinary diversion are compared. In six patients a Kock pouch was used. Two were completely successful but the other four patients required 10 revision operations between them and only two achieved complete continence. In seven patients a Mitrofanoff operation was done. The results were much better and six achieved complete continence with only three revision operations in two patients. It was concluded that the Kock pouch was more difficult and where possible the Mitrofanoff operation should be used to form a continent suprapubic catheterisable stoma.

Alternatives to Urinary Diversion with a Bag: Results in 100 Patients

“…This series, supported by experimental work in our unit, shows that it is easier to make a Mitrofanoff valve continent than a Kock nipple (Cumming et al, 1987;Malone et al, 1989). We have not found one type of intestine to be better than another for the reservoir.…”

“…Early experience and reports from other centres suggested that the complication rate was about 30% (Kock et al, 1978;Dounis and Gow, 1979;Cumming et a/., 1987;Skinner et a/., 1989). Early experience and reports from other centres suggested that the complication rate was about 30% (Kock et al, 1978;Dounis and Gow, 1979;Cumming et a/., 1987;Skinner et a/., 1989).…”

“…In this system a narrow tube, especially the appendix, was buried in a submucosal tunnel in the reservoir wall (Mitrofanoff, 1980;Cumming et al, 1987;Woodhouse et al, 1989). It was assumed that ICSC would be necessary unless the nerve supply was normal.…”

The mitrofanoff principle for continent urinary diversion

“…The technique of using the stump of a ureter after trans-uretero ureterostomy (TUU) has been described by my group [6]. Unfortunately, it has not stood the test of time in cases in which the ureter was of completely normal calibre to start with.…”

“…The pressure generated within the lumen of the conduit is 2-3 times higher than that created within the reservoir; hence, continence is preserved even when the intra-abdominal pressure is raised by straining. Conversely, the pressure generated in the lumen of a Kock nipple is only slightly higher than that created in the reservoir, resulting in less reliable continence [6,14,17].…”