Indications for creation of a continent catheterisable channel using the Mitrofanoff principle in adults are varied and long term data in this challenging patient cohort are lacking. The effect of urinary reservoir type on Mitrofanoff outcomes has not been evaluated in adults. We have assessed the effect of type of urinary reservoir on channel usage and requirement for revision.

We performed a retrospective review of consecutive patients over the age of eighteen having creation of a continent catheterisable channel using the Mitrofanoff principle at our institution between 1985-2013. We evaluated outcome in terms continued use, continence and need for revision surgery for continence (UI) or catheterisation (ISC) issues. We correlated these outcomes with urinary reservoir type. Statistical analysis was by Chi Squared analysis and Students T-Test. This was a single centre multi surgeon series, with nine consultant surgeons with a sub-specialist interest in reconstructive urology undertaking Mitrofanoff channel formation during this study period (sequentially and in parallel). Demographic information was collected, including: age at surgery, gender and length of follow up. Data regarding concomitant or prior surgical procedures such augmentation cystoplasty or neobladder formation were recorded. 

Patients were generally discharged 5-10 days post their surgery with a 12Ch - 16Ch catheter in their channel, often in addition to a urethral or suprapubic catheter, for 6 weeks until the anastomosis had healed. They were then brought back for ‘activation’ of their channel with instigation of clean intermittent self catheterisation via their continent channel. Patients were typically reviewed at 6 months thereafter with renal ultrasound and bloods including urea & electrolytes, folate, sodium bicarbonate and vitamin B12. Notwithstanding any issues, patients were generally reviewed annually thereafter with blood results and an alternating regimen of renal ultrasound and MAG3 renogram imaging.

The 176 patients a median of 60 months (range 2-365) follow-up (FU) available. Outcomes at last FU are listed in Table 1.

In total, 22% (n=39) of patients had their continent catheterisable channel created in a native bladder with 39% (n=69) having construction of their channel in a neobladder and another 39% (n=69) into a prior or concomitantly constructed augmentation cystoplasty. The majority of patients with neobladders (n=59, 85%) had channels which were in use at last follow up, with slightly lower numbers utilising their channels in those with native bladders (n=25, 64%) and bladders with a prior clam cystoplasty (n=50, 73%).

Mitrofanoff channel formation into a neobladder is associated with a significantly lower need for endoscopic or open revision for urinary incontinence than when formed into a clam cystoplasty and a significantly higher rate of continued usage than when formed into a native bladder. This data may be helpful in counselling patients who are undergoing concomitant surgical procedures at the time of their continent catheterisable channel formation.