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Mitrofanoff Continent Catheterizable Conduits: Top down or bottom up?
Jared Berkowitz, Amanda North, Ricky Tripp*, John P Gearhart, Yegappan Lakshmanan
Johns Hopkins Hospital, Baltimore, MD

Introduction:
During augmentation and Mitrofanoff procedures, conduits are usually implanted into the posterior bladder wall. Anatomical considerations may necessitate an anterior conduit placed in the tenia, or a serosal hammock. To compare the relative drainage efficiency in patients with posterior and anterior conduits, we studied their rates of bladder stone formation and urinary tract infections (UTI).

Methods:

An Institutional Review Board approved retrospective chart review identified bladder exstrophy patients who underwent augmentation and Mitrofanoff between 1991 and 2003. Only patients with 3 years or greater follow-up at our institution were included. Fifty-four patients fit this criteria, with a conduit implanted anteriorly (33), or posteriorly (21). We compared rates of bladder stone formation and UTI between these groups. In addition, stomal revisions, and the status of the bladder neck were noted.

Results:

	Anterior	Posterior	P value
Total number	33	21
Mean Age (Range)	9.1 years (5-18 years)	10 years (3-38 years)	N/S
Male / Female	24 (72.7%) / 9 (27.2%)	14 (66.7%) / 7 (33.3%)	N/S
Bladder Stones	16 (48.4%)	6 (28.5%)	P=0.2
UTI	12 (36.3)	1 (4.7%)	P<0.01
Stomal Complications	14 (42.2%)	10 (47.6%)	N/S
Bladder neck closed / open	26 (78.8%) / 7 (21.2%)	13 (61.9%) / 8 (38.1%)	N/S

Conclusions:

Stomal complications and bladder neck status were comparable between the two groups. Patients with anterior conduits had an increased risk of UTI and bladder stone formation compared to posterior conduits, although bladder stone rate was not statistically significant. This may indicate sub-optimal bladder drainage and should be addressed with careful preoperative counseling and close follow-up.

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