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Are there any long term negative side effects.....

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  • Are there any long term negative side effects.....

    of having a Mitrofanoff & bladder augmentation surgery.

    Is this method good for long term?

  • #2
    Here are two recent studies reporting 15 and 20 year followups:

    • Harris CF, Cooper CS, Hutcheson JC and Snyder HM, 3rd (2000). Appendicovesicostomy: the mitrofanoff procedure-a 15-year perspective. J Urol. 163 (6): 1922-6. Summary: PURPOSE: Appendicovesicostomy was introduced in the United States in 1982 at our hospital. It has become the most popular alternate continence channel for catheterization. We reviewed the experience of 1 surgeon with appendicovesicostomy during a 15-year period. MATERIALS AND METHODS: We retrospectively reviewed the operative reports and clinical records of 50 consecutive patients in whom appendicovesicostomy was performed by 1 surgeon between 1982 and 1998. The underlying diagnosis was myelomeningocele in 31 cases, bladder exstrophy in 6, the prune-belly syndrome in 2, posterior urethral valves in 2 and other disorders in 10. Mean patient age at surgery was 13.1 years (range 4 months to 25 years) and mean followup was 4.3 years (range 3 months to 16.3 years). RESULTS: Of the 50 patients 96% continue to catheterize the appendicovesicostomy. Stomal stenosis developed in 5 cases (10%) and other complications included stricture and appendiceal perforation in 2 each. Eight patients (16%) required appendicovesicostomy revision at a median of 7.3 months (range 1 month to 5.8 years) after the initial procedure. Median time to revision for stomal stenosis was 13 months (range 1 month to 5.8 years). Appendicovesicostomy continence was achieved in 49 patients (98%). CONCLUSIONS: Our series demonstrates the successful long-term outcome and durability of appendicovesicostomy in children. Careful adherence to technique at initial surgery helps ensure a high long-term success rate. Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
    • Liard A, Seguier-Lipszyc E, Mathiot A and Mitrofanoff P (2001). The Mitrofanoff procedure: 20 years later. J Urol. 165 (6 Pt 2): 2394-8. Summary: PURPOSE: We review our initial cases of continent cystostomy to assess long-term functional results and complications after a minimum of 15 years of followup. MATERIALS AND METHODS: Between 1976 and 1984, 23 continent cystostomies were performed on 15 boys and 8 girls with neuropathic bladders. Mean patient age at surgery was 8 years and 4 months (range 3 to 16) and mean followup was 20 years (range 15 to 23). The neurological lesions were due to 21 myelomeningocele (2 associated with an imperforated anus in 21 cases), spinal neuroblastoma in 1 and complex genitourinary malformation associated with an imperforated anus in 1. Closure of the bladder neck was performed in 21 cases (16 during the same procedure, 5 secondarily) and 2 did not undergo this procedure. The appendix was used as the catheterizable conduit in 20 cases, 1 ureter in 2 and a bladder tube in 1. Bladder augmentation was performed during the same procedure in 2 cases and at a later stage in 8. Five patients presented with unilateral or bilateral secondary vesicoureteral reflux. RESULTS: One death occurred after conversion to cutaneous diversion due to a postoperative infection leading to a ventriculoperitoneal valve infection. The remaining 22 patients were followed every 6 to 12 months. No metabolic disorder, secondary malignancy or spontaneous bladder perforation was noted. Bilateral upper tract deterioration was found in 10 cases leading to secondary bladder augmentation by enterocystoplasty in 6 and creation of noncontinent diversion in 4. Leakage occurred after bladder neck closure in 5 patients. Bladder stones were found in 5 patients (2 had prior bladder augmentation). Complications related to the conduit included stomal stenosis or persistent leakage in 11 cases, which required surgical revision and/or repeated dilations and 1 noncontinent diversion after revision failure. Five patients presented with intestinal occlusion due to volvulus in 3 and adhesion in 2. We noted that after 10 years of followup complications were rare and concerned mostly the catheterizable conduit. Therefore, 16 patients had a good and stable result while 6 have noncontinent diversion. CONCLUSIONS: The rate of complications has a tendency to decrease with time. The results obtained in this series may appear less satisfactory than those of more recent series, which may be due to the fact that these oldest continent cystostomies correspond to acquisition of experience of this novel approach, and to a period when the concept of low pressure reservoir was not yet established and bladder augmentations were not routinely performed. Since 1984 no continent cystostomy performed at our institution was converted into a noncontinent diversion. This series with long followup demonstrates that continent cystostomy is a procedure with lasting efficiency. Department of Pediatric Surgery, University Hospital Charles Nicolle, Rouen, France.


    • #3
      Is there any updated information about these surgeries? My augmentation used bowel and the Ileocecal valve as the conduit to catheterize. It was performed by Dr. Schlomo Raz at UCLA.

      The past few years, I have suffered from GI issues, namely non- stop belching and a gas-filled distended belly. Nasty bowel movements mostly soft to diarrhea followed by loads of thick mucous and watery liquid often accompanied by lots of red blood.

      no conclusive cause has been determined after a myriad of tests including food allergies and sensitivities, parasites, cat scans, colonoscopy, etc. Experimentally, my GI put me on a regiment for SIBO (small intestinal bacterial overgrowth) with the FODMAP diet and prescribed Xifaxan ( one month on, the next off and then to repeat).

      For or the first time in about three years, I stopped belching and the effervescent feeling in my GI disappeared. My stools are much better, no blood, but often still soft.

      in my research, I found SIBO was associated with removal of the ileoceacal valve because it no longer prevents the back flow of the bacteria in the large bowel back up into the small valve. As a result, this bacteria builds up in this area.

      Wondering what anybody thinks about that theory.

      Also, because of absorption issues and metabolic changes, should supplements be taken? For example, Vitamin B and potassium? Would one benefit from taking sodium bicarbonate citrate (baking soda)?


      • #4
        "Leakage occurred after bladder neck closure in 5 patients."

        How could that happen?
        Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

        T-11 Flaccid Paraplegic due to TM July 1985 @ age 12


        • #5
          It could be due to a "Fistula"


          • #6
            Future risk for complications such as small bowel obstruction (which I had) resulting from postsurgical adhesions in the pelvic area. In my case extremely bad orthopedic neurological issues in my thumb and wrist resulting from my catheterization technique as a quad.

            I don't even think I can go to an indwelling because the amount of mucous production I have on a daily basis clogs up the indwelling on a daily basis, resulting in AD. This is most problematic when hospitalized.


            • #7
              Leakage can occur because the pressure is high - forcing the urethra open a little.

              The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.


              • #8
                I believe if your surgery is extra peritoneal, the chances of bowel obstruction is lessened/rare.


                • #9
                  Thanks for the info.....