CONTINENT APPENDICOCOLOSTOMY - A VARIATION OF THE MITROFANOFF PRINCIPLE IN PEDIATRIC URINARY-TRACT RECONSTRUCTION

There are numerous options for continent urinary reconstruction in children. If the appendix is available and the bladder capacity is satisfactory, a Mitrofanoff procedure may be performed using the appendix as a catheterizable tube implanted into the bladder. However, in many patients the bladder is absent or too small for this type of reconstruction. An alternative technique, termed appendicocolostomy, is to implant the appendix under the tenia of a detubularized patch of cecum or sigmoid colon, which becomes part of a continent neobladder or is attached to the bladder itself. This procedure has been used in 12 children and 1 adult undergoing continent reconstruction. Urological diseases included bladder exstrophy (10 patients) and a neuropathic bladder (3). Two patients underwent undiversion of a sigmoid conduit, while in 7 of the remaining patients the bladder was included in the reservoir. In 1 patient histological examination of the tip of the appendix revealed an incidental invasive carcinoid tumor necessitating appendectomy and revision of the reconstruction. Otherwise, no complications have occurred. Three adults were scheduled for this procedure but the appendix was diseased and an alternative form of diversion was necessary. Followup ranged from 2 months to 4 years. All patients are totally dry with a capacity of 300 to 750 cc (mean 475 cc). The appendicocolostomy is a superior form of conduit reconstruction that should be considered when the appendix is available during continent reconstruction. However, in adults the appendix may be fibrotic, precluding its use. Because most boys with exstrophy and a small bladder capacity requiring augmentation cystoplasty must perform intermittent catheterization, attachment of the appendix to the reservoir is an alternative that allows for easier and less painful intermittent catheterization than catheterization of the reconstructed epispadiac penis.