OBJECTIVE: The Mitrofanoff principle is a well established strategy in pediatric urology, with the appendix and Yang-Monti tube being the most used channels.
The search for an alternative tube with less morbidity is justified. Hence, we present a patient treated via an alternative approach in which the channel was constructed from two lower abdominal transverse skin flaps (the RPM technique).
METHODS: A 17-year-old patient with posterior urethral valves, hypocontractile bladder and experiencing pain on urethral clean intermittent catheterization was selected. The procedure consisted of defining two rectangular transverse skin flaps of 5 × 1 cm opposite to each other. The flaps were rotated 90° and anastomosed to create a tube. A small extraperitoneal bladder wall incision was performed and the tube was connected to the bladder. Two rectal abdomen muscle strips were crossed in the midline as a neosphincter.
RESULTS: The patient had an uneventful postoperative course and remains continent for intervals of 4 h. The stoma and incision have a good cosmetic aspect at 16 months follow-up.
CONCLUSION: The RPM technique is an alternative approach for a minimal invasive strategy according to the Mitrofanoff principle. Long-term follow-up is necessary to confirm the excellent initial results.
Written by:
Macedo A Jr, Rondon A, Bacelar H, Leslie B, Ottoni S, Liguori R, Garrone G, Ortiz V. Are you the author?
Federal University of São Paulo, Rua Maestro Cardim, 560 cj 215, 01323 000 São Paulo - SP, Brazil.
Reference: J Pediatr Urol. 2012 Aug;8(4):437.e1-2.
doi: 10.1016/j.jpurol.2012.02.003
PubMed Abstract
PMID: 22445748
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