Application of appendix in treatment of children with neurogenic dysfunction of bladder and anal canal

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Application of appendix in treatment of children with neurogenic dysfunction of bladder and anal canal

Journal Title: Postępy Nauk Medycznych - Year 2013, Vol 26, Issue 5

Abstract

&lt;b&gt;Introduction.&lt;/b&gt; The aim of the treatment of neurogenic bladder and anal canal dysfunction is the prevention of upper urinary tract deterioration, urinary and fecal continence and controlled bowel movements. The application of Mitrofanoff appendicovesicostomy or Malone appendicostomy facilitates bladder catheterization and bowel movements control which are essential elements of the treatment.&lt;br&gt;&lt;b&gt;Material and methods.&lt;/b&gt; In 2002-2012 appendicular stomas were performed in 23 children with neurogenic bladder and anal canal dysfunction. 19 Mitrofanoff and 7 Malone stomas were done. In 3 children simultaneous Mitrofanoff and Malone stomas were performed. In 4 children autoaugmentation and in 4 children enteric bladder augmentation were done. We keep catheters in the stomas for 6 weeks. After this time the Mitrofanoff stoma is catheterized every 3 hours. The appendix had been sutured to the umbilicus or to the V-shape skin flap or using VQZ-plasty in the lower abdomen. To create Malone stoma we use appendix which is not detached from the cecum.&lt;br&gt;&lt;b&gt;Results. &lt;/b&gt;Complete obstruction of the Mitrofanoff stoma was observed in 3 children. 1 child has a urine leakage through the stoma. Malone stoma stricture developed in 2 children and redo operation was necessary. The unaesthetic mucosal eversion is observed in 6 children, among them is only 1 child operated on with VQZ-plasty.&lt;br&gt;&lt;b&gt;Conclusions.&lt;/b&gt; We recommend appendical stomas for intermittent bladder catheterization or antegrade enemas in children with neurogenic blader and anal canal dysfunction. The stomas can be effectively catheterized by the children themselves.

Authors and Affiliations

Grzegorz Kudela, Marta Bunarowska, Tomasz Koszutski, Janusz Bohosiewicz

Keywords

neurogenic bladder Constipation Cutaneous Fistula Urinary Fistula pęcherz moczowy neurogenny zaparcia przetoka skórna przetoka moczowa

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