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Introduction
The treatment of urinary and faecal incontinence has
improved dramatically over the last two decades, after
the introduction of the MitrofanoC principle and the
Malone antegrade colonic enema (MACE) procedure,
respectively [1,2]. For both of these procedures, the
appendix is the favoured catheterizable conduit but
problems arise when the appendix is absent or both
procedures are performed simultaneously [3]. Therefore,
diCerent conduits have been devised using tapered ileum,
caecal flaps, tubularized colon, gastric tubes, ureter,
fallopian tube, detrusor muscle, prepuce and button
devices [411].
Recently, Monti et al. described an experimental technique of transversely tubularizing a short segment of
ileum, converting a 2 cm segment into a 7 cm tube
which could then be reimplanted following the
MitrofanoC principle [12]. It was also shown that two
segments could be anastomosed to create a 14 cm tube.
We have adapted this technique to clinical practice and
present the preliminary results.
32
14
SB
SB
SB
SB
HAR
SB
SB
SB
HAR
SB
SB
Diagnosis
6 months
5 months
4 months
8 weeks
6 months
6 months
6 months
6 months
6 months
6 months
8 weeks
Follow-up
S
S
MACE caecum
MitrofanoC
bladder
Single/double
ileal segment
MitrofanoC
bladder +
MitrofanoC
bladder
MACE
caecum
MitrofanoC
bladder
MACE
A colon
MACE
A colon
MACE
A colon
MACE
T colon
MACE
A colon
MACE
T colon
Conduit
Appendix MACE
Ileocystoplasty
Pippe-Salle UL
Appendix MACE
Ileocystoplasty
Pippe-Salle UL
Ileocystoplasty
None
Appendix MitrofanoC
Pippe-Salle UL
Appendix MitrofanoC
Ileocystoplasty
Pippe-Salle UL
None
Other procedure
at same operation
Umbilical
MitrofanoC stoma
revised
MACE stoma Easy
Easy
Easy
Easy
Easy
Easy
Easy
Easy
Minimal ACE
stomal stenosis
Minimal ACE
stomal stenosis
Easy
Catheterization
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Continent
SB, spina bifida. HAR, high anorectal malformation. T, transverse. A, ascending. D, double. S, single. UL, urethral lengthening. F-C, faecally clean. U-D, urinary-dry.
50
11
11
11
17
10
15
Age
(years)
Patient
UD
FC
FC
UD
UD
FC
FC
UD
UD
FC
UD
FC
UD
FC
FC
UD
FC
FC
Outcome
254
I. D. SU GAR MAN et al.
1a
255
1b
Discussion
Results
The follow-up ranged from 8 weeks to 6 months
(Table 1). Six of the eight patients with the MACE
catheterized daily and two on alternate days; all the
conduits were continent. The six who catheterized daily
1998 British Journal of Urology 81, 253256
256
6
7
9
10
11
12
13
14
15
16
17
Authors
References
1 MitrofanoC P. Cystostomie continente trans-appendiculare
dans le traitment des vessies neurologiques. Chir Pediatr
1980; 21: 297305
2 Malone PS, Ransley PG, Keily EM. Preliminary report: the
antegrade continence enema. Lancet 1990; 336: 12178
3 Roberts JP, Moon S, Malone PS. Treatment of neuropathic
urinary and faecal incontinence with synchronous bladder