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Bladder stones are a common complication after augmentation cystoplasty and urinary diversion. However, the treatment of recurrent cystolithiasis in neuropathic children remains a real challenge for urologists and open procedures may be associated with significant morbidity. Currently, mini-invasive management options are available in the therapeutic armamentarium. Herein, we reported a case of Mitrofanoff cystolitholapaxy using a mini PCNL-kit, in a 14-year-old patient with the history of neurogenic bladder due to myelomeningocele managed by bladder augmentation. This technique has been previously described but we have added a unique modification using Nelaton catheter for carefully dilating the Mitrofanoff stoma before inserting an Amplatz sheeth and we report tips and tricks to guarantee a stone free status with one single procedure. Using high energy Holmium laser, this approach is safe and effective even with large stone burden., Highlights • The treatment of cystolithiasis in neuropathic patients with a bladder-neck closure represents a surgical challenge. • Open cystolithotomy is a good option to treat large stone burdens or multiple calculi. • For recurrent stones, endoscopic treatment via a catheterizable channel is an effective option, especially for patients with a closed bladder neck and low-burden stone. • Dilating the channel is the key step. Using serially Nelaton catheter (10-16Fr) is a good trick to preserve the integrity of the Mitrofanoff stoma.

A small proportion of patients with EB develop genitourinary disorders, which can nevertheless have a major impact on their morbidity. We present the case of a 7-year-old boy with junctional EB who presented with dysuria and lower back pain caused by bladder lithiasis complicating posterior urethral stenosis, surgical management, and postoperative outcomes.

Despite theadvancements in surgical reconstructive techniques for bladder exstrophy-epispadias complex, urinary incontinence represents a major problem that affects the quality of life. Bladder augmentation associated to Mitrofanoff external continent urinary diversion (ECUD) constitute for some surgeon the best solution for the management of bladder exstrophyallowing to achieve continence and to preserve renal function.

IntroductionLower urinary tract reconstruction in paediatric urology represents a physiologically stressful event that is associated with high complication rates, including readmissions and emergency room visits. Enhanced recovery after surgery (ERAS) protocol is a set of multidisciplinary, perioperative strategies designed to expedite surgical recovery without adversely impacting readmission or reoperation rates. Early paediatric urology data demonstrated ERAS reduced complications in this population.Methods and analysisIn 2016, a working group of paediatric urologists and anaesthesiologists convened to develop an ERAS protocol suitable for patients undergoing lower urinary tract reconstruction and define study process measures, patient-reported outcomes and clinically relevant outcomes in paediatric and adolescent/young adult patients. A multicentre, prospective, propensity-matched, case–control study design was chosen. Each centre will enrol five pilot patients to verify implementation. Subsequent enrolled patients will be propensity matched to historical controls. Eligible patients must be aged 4–25 years and undergoing planned operations (bladder augmentation, continent ileovesicostomy or appendicovesicostomy, or urinary diversion). 64 ERAS patients and 128 controls will be needed to detect a decrease in mean length of stay by 2 days. Pilot phase outcomes include attainment of ≥70% mean protocol adherence per patient and reasons for protocol deviations. Exploratory phase primary outcome is ERAS protocol adherence, with secondary outcomes including length of stay, readmissions, reoperations, emergency room visits, 90-day complications, pain scores, opioid usage and differences in Quality of Recovery 9 scores.Ethics and disseminationThis study has been registered with authors’ respective institution review boards and will be published in peer-reviewed journals. It will provide robust insight into the feasibility of ERAS in paediatric urology, determine patient outcomes and allow for iteration of ERAS implementations as new best practices and evidence for paediatric surgical care arise. We anticipate this study will take 4 years to fully accrue with completed follow-up.Trial registration numberNCT03245242.

The Mitrofanoff procedure has enhanced practical management of urinary incontinence over the past 20 years by means of an abdominal stoma catheterisation for patients suffering from neuropathic bladder. This procedure has been modified when there is no viable appendix to enable similar tubularisation and conduit formation from parts of the gastrointestinal tract, also known as the Monti technique. While ileum is more consistently used in a Monti procedure, in this particular case a Meckel's Diverticulum (MD) lent for an alternative option. Herein, this case report allows us to demonstrate the use of a MD as a viable option if and when the opportunity allows, in the absence of appendicular tissue.

Bladder exstrophy-epispadias complex (EEC) is a rare congenital defect where the abdominal muscles and bones fail to close in the mid-pelvis. It is crucial to understand the health-related quality of life (QOL) of exstrophy patients who have undergone multiple correctional surgeries. We herein discuss a case of bladder EEC that was repaired through a series of procedures at a resource-limited hospital in Karachi, Pakistan. A 21-year-old male, who was born with EEC, underwent bladder augmentation, Mitrofanoff procedure, bladder neck reconstruction, ureter implantation and a right nephrectomy in a single one-stage procedure during late childhood for urinary incontinence. However, this required a further revision because the urinary incontinence persisted, with difficulty in catheterizing the Mitrofanoff channel. On follow-up after 10 years, our patient currently describes normal QOL with near-normal sexual function. Validated questionnaires for QOL, erectile dysfunction, incontinence and prostatic function were used to assess the patient's post-operative status in these domains. Through our report, we conclude that such patients can have a normal QOL by means of a holistic multidisciplinary management, which includes timely surgical corrections along with an additional focus on the psycho-social and sexual aspects of this condition.

Over the last half century, significant improvements in health outcomes for individuals with spinal cord injury (SCI) and growing recognition those women with SCI can become pregnant. However, pregnancy must be rated as high risk and requires multidisciplinary medical care as higher rate of complication compare to general population. Most of published literature grouped all patients with lower urinary tract reconstruction (LUTR) like exstrophy–epispadias complex, spina bifida, interstitial cystitis urogenital sinus or fistula, but our article is focusing in the childbearing SCI women who undergone cutaneous continent urinary diversion (CCUD) with mitrofanoff procedure. We report two cases of three successful pregnancies in this population.

We describe the case of a bladder exstrophy–epispadias complex (BEEC), in which a “split” appendix was used simultaneously as a posterior urethral replacement (for strictured Mitchell's repair) as well as a Mitrofanoff channel. Split appendix had been used before for simultaneous Mitrofanoff and Malone's antegrade contrast enema channels to manage neurogenic bladder and bowel. To the best of our knowledge, this is the first reported case for the use of split appendix for urethral reconstruction in a child with BEEC.

Recurrent urolithiasis is a common and potentially morbid complication of spina bifida. Although the size, the location, and the composition of these stones often necessitates percutaneous intervention, access is often complicated by body habitus and spinal deformity. There is little consensus regarding the approach to percutaneous lithotripsy when a clear path to the collecting system is unavailable, particularly in the setting of surgically augmented urological anatomy. Here we present the first known case in which a pediatric patient with spina bifida underwent percutaneous lithotripsy of bladder stones via a transpsoas approach. Keywords: Cystolitholopaxy, Transpsoas, Mitrofanoff, Appendicovesicostomy, Stone extraction

Introduction : la colonisation urinaire et le surrisque infectieux des patients avec un bas appareil urinaire (BAU) reconstruit avec du tube digestif ont longtemps rendu réticents les néphrologues et les urologues à transplanter ces patients, pourtant souvent jeunes et pour lesquels le bénéfice attendu de la transplantation est grand. L’objectif de cette thèse était d’appréhender les résultats de la transplantation rénale des patients avec reconstruction du BAU. Méthodes : les patients transplantés rénaux sur un BAU reconstruit avec du tube digestif issus de 2 centres français entre 2005 et 2016 ont été inclus (n=26). 23 de ces patients ont été appariés à 46 témoins par la méthode des scores de propension. Les survies des greffons et des patients et les fonctions rénales à 3 mois, 1 an, 5 ans et 10 ans ont été comparées. La survenue de pyélonéphrites et la survenue de complications chirurgicales ont été comparées et les facteurs associés à leur survenue ont été recherchés. Résultats : la survie des greffons à 1 an, 5 ans et 10 ans était respectivement de 98%, 88% et 69% dans le groupe avec reconstruction du BAU et de 96%, 89% et 70% dans le groupe appariés (p=0,974). Les patients avec reconstruction faisaient significativement plus de pyélonéphrites (65% vs 17%, p

Objectives: To evaluate the long-term results after the construction of a Continent Catheterizable Urinary Conduit (CCUC) in adults.Methods: This study retrospectively reviewed the charts of 41 adults from two tertiary centers who received a CCUC. The demographics, underlying diseases, indications for a CCUC and outcomes such as the reoperation rate and the occurrence of complications were extracted. The patient reported outcome was measured with the Patient Global Impression of Improvement (PGI-I) scale and four additional questions about continence, leakage and stomal problems. Results: Twenty-nine patients were women. The median age at surgery was 32 years, with a median follow-up of 52 months. Twenty-six patients had a neurogenic bladder. The reoperation rate was 48.8%, with a median of 10.5 months after constructing the CCUC. Superficial stomal stenosis was the most common registered complication (20 times) and stoma revision was the most often performed reoperation (12 times). Twenty-four patients completed the PGI-I; the mean improvement rating was 2 (=much better).Conclusion: The construction of a CCUC in adults is associated with a high complication and reoperation rate. The high reoperation rate is in accordance with the sparse literature. Despite this, patients reported 'much better' on the PGI-I.

Cutaneous catheterizable channels allow for continent bladder emptying when an alternate route is desired. The goals of channel creation in the neurogenic bladder population are successful urine elimination, renal preservation, continence and lastly cosmesis. In addition to a particular surgeon's comfort and experience with a given procedure, individual patient factors such as medical comorbidities, anatomic factors, and occupational function should be central to the selection of a surgical approach. An ideal channel is one that is short, straight, and well supported by associated blood supply and surrounding adventitia, so as to minimize difficulty with catheterization. Two types of channel continence mechanisms are discussed at length in this review-the tunneled channel, and the nipple valve. The appendicovesicostomy (Mitrofanoff), and reconfigured ileum (Yang-Monti) are both tunneled channels. The ileocecal valve is a commonly used nipple valve and provides continence when reinforced. The continent catheterizable ileal cecocystoplasty (CCIC) is an example of this channel technique. This method couples a tapered ileal limb as a catheterizable channel, the ileocecal valve as the continence mechanism, and the cecum and ascending colon as a bladder augmentation. While this procedure has higher perioperative complications relative to a simple tunneled channel, it has increased channel length flexibility and is also coupled with a bladder augment, which is completely performed using one bowel segment. Continent channel creation in adults can improve quality of life and minimize morbidity associated with neurogenic bladder. However, the decision to proceed with creation of a catheterizable channel should be made only after careful consideration of the patient's medical comorbidities, physical abilities social support, and surgeon experience.

Background: In 1980, Mitrofanoff described the creation of an appendicovesicostomy for continent urinary diversion. This procedure greatly facilitates clean intermittent catheterisation in patients with neurogenic bladder. The purpose of our study was to determine the clinical efficacy of the laparoscopic Mitrofanoff catheterisable stoma for children and adolescents with spina bifida. Materials and Methods: Review of hospital records revealed that 11 children with spina bifida underwent a laparoscopic Mitrofanoff procedure with at least 1-year of follow-up. A four-port transperitoneal laparoscopic approach was used to create a Mitrofanoff appendicovesicostomy. The child was followed-up in the urology clinic at 6 weeks, 3 months, 6 months, 1-year, and then semiannually after that. Questionnaires were administered to determine, from the children′s perspective, the level of satisfaction with catheterisation and the psychosocial implications of catheterisation before and after the creation of the Mitrofanoff continent catheterisable stoma. Results: Of the 11 children, six were female, and five were male. The mean age at presentation to Paediatric urological services was 11 × 3.22 years. Overall the mean operative time was 144.09 × 17.00 min. Mean estimated blood loss was 37.36 × 11.44 cc. None of the cases needed conversion to open. Patient satisfaction with their catheterisation was measured at 2.18 × 0.98 preoperatively, Post-operatively, this improved to 4.27 × 0.46. Statistical analysis using paired t-test showed significance with P < 001. Conclusions: Laparoscopic Mitrofanoff catheterisable stoma is feasible in children with spina bifida and is associated with reasonable outcome with early recovery, resumption of normal activities and excellent cosmesis.

Les autosondages sont nécessaires pour assurer une vidange régulière de la vessie, chez des patients porteurs d’une vessie neurologique. L’accès à l’urètre est difficile pour des patients à mobilité réduite, obèses ou impossible en cas d’urètre sténosé. La dérivation urinaire cutanée continente est une alternative chirurgicale aux auto-sondages urétraux et au Bricker. L’objectif de cette étude était d’évaluer la continence urinaire stomiale à long terme. Les objectifs secondaires évaluaient les complications chirurgicales entre les 2 types de montages; transappendiculaire et tube iléal remodelé. Un questionnaire a estimé l’impact sur la qualité de vie du patient. Notre étude de cohorte, rétrospective, était établie sur une population de patients opérés d’une cystostomie continente première. La cohorte est composée de patients porteurs de vessies neurologiques (84%) avec 54% de blessés médullaires. 45 patients ont été opérés entre Juin 1997 et Mars 2015, La dérivation urinaire cutanée a été réalisée en transappendiculaire (67%). Avec un suivi médian de 64 mois, la continence urinaire stomiale était de 88%. 64,5% des patients ont nécessité une ou des réinterventions, notamment pour sténose stomiale (31%). La qualité de vie était améliorée. Aucune différence en terme de continence urinaire ou de complications n’a été mise en évidence entre les deux montages. La dérivation urinaire cutanée selon Mitrofanoff est une alternative chirurgicale fiable sur le long terme, mais nécessitant des réinterventions pour maintenir un conduit fonctionnel continent et cathétérisable. En dépit des réinterventions les patients restent satisfaits de ce mode mictionnel.

Introduction: The Mitrofanoff principle was originally described as a method to provide an alternative means to access the bladder. It creates a conduit to the bladder through which patients with a sensitive, absent, or traumatized urethra can perform clean intermittent catheterization (CIC) easily. We report our experience with complete laparoscopic Mitrofanoff appendicovesicostomy to promote a catheterizable abdominal stoma. Materials and Methods: A 4-port transperitoneal approach was used to create a complete laparoscopic Mitrofanoff appendicovesicostomy. Results: Six children with a mean age of 12.8 years (range 9-16 years) underwent laparoscopic Mitrofanoff appendicovesicostomy. Mean operative time was 139.6 min and Mean estimated blood loss was 46 cc. No cases of urinary leaks were noted. There have been no cases of either stomal stenosis or appendicovesical stenosis noted. Conclusions: Pure laparoscopic Mitrofanoff appendicovesicostomy is feasible and is associated with reasonable outcome with early recovery, resumption of normal activities and excellent cosmesis.

Aims: This study aims to describe our surgical technique and report our preliminary experience with laparoscopic ileal or appendicovesicostomy in adult patients with neurogenic bladder caused by spinal cord injury. Subjects and Methods: From January 2014 to March 2017, seven patients were submitted to an appendicovesicostomy under Mitrofanoff procedure and two patients to an ileovesicostomy under Yang-Monti procedure by laparoscopy. Clinical indications were patients with a history of neurogenic bladder secondary to spinal cord pathology, with proper dexterity and willing to have a more accessible continent derivation. Surgical steps include: (1) identification and mobilization of appendix; (2) ligation of appendix' base; (3) endoloop reinforcement of proximal end; (4) silicon catheter insertion in appendix' lumen; (5) mesoappendix dissection; (6) Retzius space opening; (7) posterior bladder dissection; (8) anterior transcutaneous bladder dome fixation; (9) vertical midline detrusor incision; (10) opening of bladder mucosa; (11) excision and espatulation of appendix tip; (12) appendico vesical anastomosis; and (13) exteriorization of appendix through umbilicus and creation of catheterizable stoma. In the two patients submitted to a Yang-Monti diversion, the ileum reconfiguration and calibration was done extracorporeally. One patient had simultaneous bladder augmentation. Results: The mean follow-up was 21.5 ± 11.9 months. The mean operative time was 161 min (123–220). There was no conversion to laparotomy and no need of postoperative blood transfusion. The mean hospitalization length was 4 days. No early postoperative complication was registered. Late postoperative complications were: one surgical stoma revision, one false-passage (solved by transient catheterization), and one bladder stone (solved by endoscopic approach). All patients are continent. Conclusions: This series presents our laparoscopic technique for continent urinary diversions, showing that it is feasible and safe in adult patients with neurogenic bladder.

Introduction and objectives Bladder stones are the most common calculi of the lower genitourinary tract. The most common predisposing factor is the bladder outlet obstruction. The present case concerns a patient who suffered urethral trauma after a pelvis fracture, requiring a Mitrofanoff urinary diversion, and was diagnosed with multiple cystolithiasis up to 1 cm. The objective of these paper is to show the possibility of performing a percutaneous cystolithotomy in a patient with a complex urinary diversion, being an intervention with low morbidity, and with shorter recovery time and comparable results in terms of stone free percentage rate. Materials y methods The procedure starts with a prior Mitrofanoff catheterisation with a Foley catheter 12. An ultrasound-guided suprapubic left paramedian puncture was performed, followed by Chiba needle hydrophilic guidewire, stiletto, telescoped Alken dilators 9Fr-22Fr, and 28Fr Amplatz sheath. Once the percutaneous tract is established, the nephroscope and foreign body forceps were introduced and complete stone removal was achieved. The procedure ended with the extraction of the Amplatz sheath and occlusion of the wound with gauze dressing, maintaining the bladder diversion with the Foley catheter to a draining collector system. Discharge was given at day 1 post-operative, nad the Foley catheter was removed after 5 days. Results No complications occurred, the operative time was 1 hour, and 1 day of hospital stay. Satisfactory recovery with a successful outcome in terms of complete stone removal in only 1 surgery. Conclusions Percutaneous cystolithotomy is a management option which offers advantages comparable with other techniques. It should not just be considered in patients with urethral restricted access. © 2015 Sociedad Colombiana de Urología

Los cálculos vesicales son los más frecuentes del tracto urinario bajo (1). El factor predisponente más frecuente para la formación de cálculos vesicales es la obstrucción del tracto de salida. Presentaremos el caso de una paciente con antecedente de trauma uretral por fractura de pelvis; derivada con un Mitrofanoff; con diagnostico de cistolitiasis múltiple con cálculos de hasta 1 cm. El objetivo es mostrar la posibilidad de manejo de la cistolitiasis vía percutánea en una paciente con una derivación urinaria compleja funcionante, procedimiento menos mórbido, con menor tiempo de recuperación y con resultados comparables a otras técnicas. Inicia el procedimiento previa cateterización del Mitrofanoff con sonda Foley 12Fr, realizando punción suprapúbica para mediana izquierda a 2 cm de la rama púbica con aguja Chiba, posteriormente se avanzó guía hidrofílica seguida de varilla y dilatadores secuenciales de Alken 9Fr-27Fr y colocación de camisa Amplatz 28 Fr. Se retiraron dilatadores conservando guía de seguridad, se extrajeron la totalidad de los cálculos. Se ocluyó herida y se dejó sonda Foley conectada a Cystoflo. Egreso al día 1 post operatorio y retiro sonda Foley a los 5 días post operatorio. No se presentaron complicaciones, el tiempo operatorio fue de 1 hora, con 1 día de estancia hospitalaria. Recuperación satisfactoria con un resultado exitoso en cuanto a la extracción completa de los cálculos en 1 sólo tiempo quirúrgico. La cistolitotomía percutánea es una opción de manejo la cual ofrece grandes ventajas. Debe ser considerada no sólo en pacientes con acceso uretral restringido. Bladder stones are the most common calculi of the lower genitourinary tract (1). The most common predisposing factor is the bladder outlet obstruction. The present case, is about a patient, who suffered urethral trauma after a pelvis fracture, requiring a Mitrofanoff urinary diversion; who was diagnosed with multiple cystolithiasis up to 1 cm. The objective of these paper is to show the possibility of performing a percutaneous cistolithotomy in a patient with a complex urinary diversion, being a less morbid intervention, with shorter recovery time and comparable results in terms of stone free percentage rate. The procedure starts previous Mitrofanoff catheterization with a Foley catheter 12. Ultrasound-guided suprapubic left paramedian puncture was performed followed by Chiba needle hydrophilic guidewire, stiletto, telescoped Alken dilators 9Fr-22Fr and 28Fr Amplatz shirt. Once established percutaneous tract, the nephroscope and foreign body forceps were introduced and complete stone removal was achieved. The procedure ended with the extraction of the Amplatz shirt and occlusion of the wound with gauze dressing, maintaining the bladder derivative with the Foley catheter to a draining collector system. Discharge was given at day 1 postoperative Foley catheter was removed after 5 days. No complications occurred, the operative time was 1 hour, and 1 day of hospitalization. Satisfactory recovery with a successful outcome in terms of complete stone removal in only 1 surgery. Percutaneous cystolithotomy is a management option which offers advantages comparable with other techniques. Must be considered not only in patients with urethral restricted access.

Since the original description of the trans-appendicular continent cystostomy by Mitrofanoff in 1980, a variety of techniques have been described for creating a continent catheterisable channel leading to the bladder, which avoids the native urethra. The Mitrofanoff principle involves the creation of a conduit going into a low pressure reservoir, which can emptied through clean intermittent catheterization through an easily accessible stoma. A variety of tissue segments have been used for creating the conduit, but the two popular options in current urological practice remain the appendix and Yang-Monti transverse ileal tube. The Mitrofanoff procedure has an early reoperation rate for bleeding, bowel obstruction, anastomotic leak or conduit breakdown of up to 8% and the most common long-term complication noted is stomal stenosis resulting in difficulty catheterizing the conduit. However, in both pediatric and adult setting, reports imply that the procedure is durable although it is associated with an overall re-operation rate of up to 32% in contemporary series. Initial reports of laparoscopic and robotic-assisted Mitrofanoff procedures are encouraging, but long-term outcomes are still awaited.

To present a series of 15 laparoscopic and robot-assisted Mitrofanoff and Yang-Monti vesicostomies in an adult population, and to assess the feasibility and safety of these minimally invasive approaches.Between 2009 and 2012, 15 patients underwent laparoscopic (n = 11) or robot-assisted (n = 4) construction of vesicostomy by a single surgeon (D.R.): Mitrofanoff appendicovesicostomy (n = 11) or double Yang-Monti ileal conduit (n = 4). Fourteen patients underwent concomitant augmentation enterocystoplasty. Indications for surgery included neurogenic bladder (n = 11) and urethral dysfunction (n = 4). The patients were evaluated postoperatively using cystography. Quality of life (QoL) was evaluated using an internally developed questionnaire.All surgeries were successfully completed with no conversions. Operating time was always5 h. The mean estimated blood loss was 150 mL and the mean follow-up was 22 months. Early postoperative complications included deep retrovesical abscess (n = 2) and upper urinary tract infections (n = 4), and one patient had peri-operative cardiac failure. Late postoperative complications included stomal stenosis (n = 2), persistent low-pressure bladder incontinence (n = 1) and recurrent infections (n = 1). Surgical excision of the conduit was necessary in one patient. Postoperatively, patients showed complete bladder emptying and no leak on follow-up cystography. According to our QoL questionnaire, 13/15 patients did not regret the surgery.While a longer follow-up is needed to assess the durability of our results, this series shows that the laparoscopic and robot-assisted approaches for the construction of continent urinary diversions are feasible and safe in an adult population.

La presente monografía tuvo como objetivo fundamental, la creación de un documento que sirva como referencia bibliográfica para la investigación sobre Vejiga Neurogénica y de esta forma motivar en el proceso de enseñanza y aprendizaje, dirigido a toda clase de población que esté interesada en conocer acerca de esta enfermedad; la presente esta especialmente diseñada para el personal de la salud. El estudio se enmarcó bajo la modalidad de investigación, buscando en bases de datos, artículos y libros referentes al tema. La población a la que se tomo como objeto de investigación fueron los niños, adolescentes y sus familias ya que se identifico que son la población más susceptible de esta enfermedad. El diseño de la monografía se centro en la revisión teórica de cada unos de los aspectos relacionados con Vejiga Neurogénica. / Abstract: This paper had as its main goal the creation of a document that serves as a bibliography for research on Neurogenic Bladder and thus encourage the teaching and learning process, led to all sorts of people who are interested in learning about this disease, this is specially designed for health personnel. The study was framed in the form of research, searching databases, articles and books about the subject. The population that was taken as research subjects were children, adolescents and their families as they identify people who are more susceptible to this disease. The design of the paper focuses on the theoretical review of each of these aspects of neurogenic bladder. Pregrado

Resumen Introduccion El cuidado de los ninos con vejiga neurogenica, debe ser integral, multidisciplinario y busca preservar la funcion renal, alcanzar continencia urinaria y fecal, logrando que el paciente sea una persona autosuficiente y util a la sociedad. Metodos Describimos el resultado del uso de la tecnica de Mitrofanoff en el manejo de pacientes con disfuncion vesical neurogena, utilizada en el HUSVP desde 1998 al 2003, y las condiciones actuales de los pacientes con respecto a su enfermedad y tratamiento. Se realizo un estudio observacional descriptivo, retrospectivo 1998-2002 y prospectivo durante el 2003, analizando una serie de casos. Resultados Fueron intervenidos 41 pacientes con vejiga neurogenica. Edad promedio 10.2 anos; seguimiento promedio 27,2 meses; enfermedad de base mas frecuente mielomeningocele (46,3%); vejiga disinergica en 46,3%, esfinter hipotonico en 41,5%. Se realizo aumento vesical al 68,3%, utilizandose ileon en 71,4%, y alguna intervencion sobre el cuello vesical al 51,2%. Se hizo una derivacion tipo Mitrofanoff al 95,1% con continencia completa en 70,8%, incontinencia completa en 14.6% e incontinencia ocasional en 14,6%. En 31,7% se realizo un Malone con adecuada continencia fecal en 90,2%. De los estomas el 19% presentaron estenosis y el 21,9% presentaron escape de orina. Se encuentran socialmente adaptados 80% de los pacientes. Conclusiones Los estomas continentes cateterizables son utiles para tratar la incontinencia urinaria y fecal. Los conductos realizados con ileon tuvieron mayores complicaciones que los elaborados con apendice, por lo cual el apendice debe ser el tejido de eleccion para realizar las derivaciones, cuando este disponible.

Objetivo: presentar un caso de adenocarcinoma uretral de células claras y su manejo quirúrgico. Material y métodos: se describe la clínica, diagnóstico, tratamiento y evolución, de este tipo de tumor. Revisión de la literatura. Conclusión: es un tipo de tumor infrecuente que se asocia a mal pronóstico. La conformación de un reservorio con mecanismo de continencia tipo Mitrofanoff tiene su vigencia en este tipo de indicación. La cistectomía laparoscópica es una técnica realizable por grupos con cierto bagaje laparoscópico sin añadir grandes dificultades técnicas; no existe todavía un seguimiento a largo plazo como para valorar resultados oncológicos, pero sí se vislumbran ciertas ventajas funcionales. Objective: To present a new case of a primary clear cell adenocarcinoma of the urethra and its surgical management. Material and methods: We describe the clinical, diagnosis, treatment and development of this kind of tumor. Review of the literature. Conclusions: It is an unusual type of cancer associated with poor prognosis. Currently the construction of a continent urinary diversion using the Mitrofanoff principle has many indications as our case. Laparoscopic radical cystectomy can be done by experienced groups without adding much more technical difficulties; there are no long-term oncological outcome data but we believe in some functional advantages.

Mitrofanoff appendicovesicostomy has been the method of choice for dealing with urinary incontinence. However, there may be some cases where some alternate conduits have to be used. Yang-Monti ileovesicostomy is an alternative to Mitrofanoff appendicovesicostomy. Three boys who underwent successful Yang-Monti continent ileovesicostomy are reported in this manuscript. In the first case, Mitrofanoff procedure was done for traumatic anorectal and urethral disruption after attempting ureterosigmoidostomy. Later on, on the request of the patient the appendicovesicostomy was excised. The patient presented later with chronic renal failure and bilateral hydroureteronephrosis thus an ileovesicostomy was fashioned. The patient could not be survived due to chronic renal failure related complications. In the second patient with exstrophy of bladder, the ileocecal junction along with appendix had to be resected on account of strangulated inguinal hernia; later on, an ileovesicostomy was performed for small capacity bladder and major degree of vesicoureteric reflux. The third patient with exstrophy of bladder, in whom Mitrofanoff procedure had been performed, presented with stenosis of the appendicovesicostomy. On re-operation the entire channel had disappeared thus necessitated ileovesicostomy. Both of these patients were doing well on follow-up.