The Benefit Of A Mitrofanoff Stoma In Patients With Unusual Indications. Case Report Of Two Patients Before And After Mitrofanoff Operation

Abstract

PURPOSE It is sometimes difficult to motivate a child or adolescent to undergo a urine diversion and CIC. The aim of this report is to describe quality of life and renal function for two patients before and after Mitrofanoff diversion without bladder augmentation. MATERIAL AND METHODS Two boys,born 1994 and 1995. One boy presented at our clinic with severe incontinence, poor bladder emptying, increasing hydronephrosis and recurrent uti:s that affected his renal function. He was later diagnosed with Hinman bladder. The other boy has a congenital nephrogenic diabetes insipidus with a urine production of about 10 l/day. He expressed problems with drousiness because of lack of sleep, having to empty his bladder several times every night. He also failed to grow according to his age. Both were followed by urotherapist and urologist/nephrologist about two years before the operation and are continiously followed afterwards with urotherapy coaching, kidney function tests, blood tests etc. Both patients use a night drainage catheter. The boy with Hinman is doing CIC every four hours. RESULTS Both patients had their Mitrofanoff deviation performed in our department. One boy visited the psychologist before surgery, wich helped him cope with his fear of the operation and the CIC procedure. He also met another patient with Mitrofanoff. Today he is continent and has no more uti:s. The other patient uses his deviation only for night drainage, which has given him the possibility to sleep the whole night, something he never did before surgery. GFR improved in both boys. CONCLUSIONS Mitrofanof deviation and CIC can improve life quality and renal function for patients with unusual diagnoses. Good coaching and follow up by urotherapist and doctors are necessary for a good outcome.