Abstract General Information

Title

THE BLADDER TUBE – A NON-REFLUXING CONDUIT CREATED FROM THE AUGMENTED BLADDER – A USEFUL SURGICAL INNOVATION - AN INITIAL REPORT.

Introduction and objective

The Mitrofanoff/Monti conduit procedures are important adjunctive procedures in the management of urinary incontinence. They are usually performed along with Bladder Augmentation and Bladder Neck tightening procedures, for enabling easy CIC. However, occasionally, after years of usage, for reasons unknown, the channel can become stenosed/strictured and can cause problems in catheterisation. In some such cases a complete redo-creation of a continent conduit must be considered.
A redo Mitrofanoff using appendix is not possible and often due to adhesions in the pelvis and lower abdomen a redo-Monti is also a challenge. We share our initial experience of the creation of a Bladder tube in such situations.

Method

This is a short initial report of 3 cases who underwent Continence surgery comprising of Bladder Augmentation (colocystoplasty in all 3 cases), Anterior Rectus Fascia (in one case) and Mitrofanoff using Appendix (in 2 cases). Of the 3 cases operated for their incontinence 2 were males ( 14 yr old with NGB due to Spina Bifida and 3 year old with PUV and a small Bladder due to Bil diversions done earlier) and 1 was a girl ( 7 year old girl with NGB due to Spina Bifida).
In 2 cases (NGB female and PUV male) a Mitrofanoff channel was created using the Appendix. In these 2 patients the Bladder tube was created 4 and 5 years after the initial surgery. In the 14 yr old boy with NGB -the bladder tube was created as the primary conduit, as his Appendix was very short, and he had extensive abdominal adhesions (probably due to his VP shunt) making a Monti channel difficult.
The technique of creating the Bladder tube will be described during the presentation.

Results

In all the 3 cases the novel Bladder tube conduit has been functioning well for more than 2 years (follow up of 2-4 years). There is no difficulty in catheterization and no reflux of urine

Conclusion

This novel technique of creating a non-refluxing conduit from the Augmented Bladder (The Bladder Tube procedure) can become a very easy and effective option, especially in difficult situations where a redo conduit operation is required. Whether it can also be considered as a primary option will require further trials and evaluation.