Évaluation à long terme des cystostomies continentes de type Mitrofanoff chez l’adulte : résultats à 5 ans

Abstract

This study analyzed long-term functional outcome of continent catheterizable channels with the Mitrofanoff procedure, their continence, complications and the satisfaction of the patients. Data from patients who underwent a Mitrofanoff procedure at our institution from June 1997to March 2015were retrospectively collected. All patients were contacted at the end of the study, a survey was submitted to them. Sixty-seven patients underwent a continent cystostomy with the Mirtrofanoff procedure. Forty-five patients had the inclusion criteria: 18years old or older, no previous urinary diversion with a minimum of 6months of follow-up. The cohort comprised mainly neurologic bladder (84%) with spinal cord injuries (54%) or spina-bifida patients (15%). Median age was 35years old [22-49]. Median follow-up was 64months [39-90]. The surgical procedure used an appendicular channel: 30patients (67%) or a continent ileal plasty: 15patients (33%). At the end of follow-up: 88% patients have a full cystostomy continence, 89% full uretral continence. Twenty-nine patients had one (41%) or more reinterventions. Reasons for the 58reinterventions were: stomal stenosis (31%), uretral incontinence (29%), cystostomy incontinence (15%), lithiasis (9%). Those reinterventions were done with a local surgery (31%) or an endoscopic surgery (35%). Overall early adverse events (<30days) or delayed (>30days) adverse events were similar (P=0.93) in appendicovesicostomy group or continent ileal plasty group. Ninety-four percent patients described a satisfactory urinary comfort. The cystostomy was considered esthetic by 71%, its realization allowed an improvement of the quality of life for 89% of them. Continent channels in adults demonstrate favorable long-term outcomes even if reinterventions could be necessary to maintain a continent and catheterizable channel. Despite reinterventions, patients remain satisfied by the Mitrofanoff procedure which facilitate the process of clean intermittent catheterization. 4.