Robot-assisted Mitrofanoff and Malone antegrade continence enema reconstruction using divided appendix

Fecal soiling or intractable constipation frequently occurs in association with urinary incontinence in children with varying pathologic conditions. To manage double incontinence or the combination of wetting and severe constipation, a Mitrofanoff conduit and a channel for antegrade continence enema is constructed using the appendix by open surgery. We present a video of the first case of robot-assisted laparoscopy for simultaneous reconstruction of a continent urinary diversion using the Mitrofanoff principle and a Malone antegrade continent enema using the divided appendix.     

Bladder-sparing surgery and continent urinary diversion using the appendix (Mitrofanoff procedure) for urethral cancer

We performed bladder-sparing surgery and continent urinary diversion in two patients with urethral cancer. The first patient was a 58-year-old man with bulbomembranous urethral cancer (squamous cell carcinoma, cT2N0M0). The second patient was a 77-year-old woman with urethral cancer invading the vaginal wall (transitional cell carcinoma with squamous cell carcinoma, cT3N0M0). After bladder-sparing urethrectomy, continent urinary diversion with appendicovesicostomy (Mitrofanoff procedure) was performed in the both patients. More than 4 years after the surgery, both patients were continent, had no trouble with catheterization, and experienced no recurrence of cancer. Bladder-sparing surgery and urinary diversion based on the Mitrofanoff procedure can be considered for appropriately selected patients with urethral cancer.     

小儿阑尾输出道可控性肠膀胱术(附七例报告)

目的 探讨阑尾输出道可控性肠膀胱术在小儿泌尿外科的应用效果。方法 报道7例小儿阑尾输出道可控性肠膀胱术治疗经验。男3例女4例,平均年龄8岁。车祸致膀胱、石输尿管及双睾丸缺失1例,先天性完全性尿失禁4例（尿生殖窦畸形、膀胱外翻各1例,短尿道2例）,神经源性膀胱2例。结果 5例（70％）达到预期效果,2例仍有尿自尿道排出。结论 阑尾输出道可控性膀胱术对需行尿流改道的患儿是一种有效的手术方式。     

Pregnancy with clam ileocystoplasty and appendix Mitrofanoff procedure: vaginal delivery can be considered

The surgical treatment of intractable detrusor overactivity is complex and includes clam ileocystoplasty and appendix Mitrofanoff. Due to improved health and quality of life of these patients after surgery, the option of pregnancy is made possible for them. Pregnancy for these women can be complicated and requires multidisciplinary team input. The option of vaginal delivery can be considered in the absence of obstetric and medical contraindications.     

The use of the Mitrofanoff principle in achieving clean intermittent catheterisation and urinary continence in children

The Mitrofanoff principle has been used to achieve clean intermittent catheterisation (CIC) and urinary continence in 28 children. The mean age at operation was 10.1 years (range, 1 to 19 years). A catheterisable conduit was created using the appendix (19), ureter (8), or vas deferens (1). CIC was commenced 10 to 28 days postoperatively (median, 15 days). After a mean follow-up of 13 months (range, 2 to 45 months), 24 children (86%) have achieved successful CIC and urinary continence. Use of the Mitrofanoff principle is a valuable adjunct to the treatment of urinary incontinence in children and may allow successful CIC in patients who are unable to catheterise urethrally.     

Long-term followup of the intussuscepted ileal nipple and the in situ, submucosally embedded appendix as continence mechanisms of continent urinary diversion with the cutaneous ileocecal pouch (Mainz pouch I)

PURPOSE: We analyzed stoma related complications and continence rates in patients who underwent continent urinary diversion with the cutaneous ileocecal pouch (Mainz pouch I). We compared the intussuscepted ileal nipple and in situ, submucosally embedded appendix as continence mechanisms. MATERIALS AND METHODS: A total of 401 patients were included in a retrospective followup study. Continence mechanisms were the intussuscepted ileal nipple in 205 patients and the in situ, submucosally embedded appendix in 196. RESULTS: A total of 144 patients (36%) required intervention for a stomal complication. Of patients who received an intussuscepted ileal nipple 34 (17%) had stomal stenosis at a mean time to first stenosis of 43.8 months, 41 (20%) had stones at a mean interval to the first stone of 62.8 months, 12 underwent reoperation for stomal incontinence, including 1 because of nipple necrosis, and 82% were completely continent. Of patients who received an in situ, submucosally embedded appendix 63 (32%) had stomal stenosis at a mean time to first stenosis of 31.4 months, 20 (10%) had stones at a mean interval to the first stone of 47.5 months, 3 underwent reoperation for stomal incontinence, 4 had appendiceal necrosis and 92% were completely continent. CONCLUSIONS: Of stomal complications 63% were treated endoscopically. The higher rate of stomal stenosis with the appendiceal stoma is most likely due to the smaller diameter of the appendix. The higher rate of stone formation in patients with the intussuscepted ileal nipple is related to metal staples. Continence rates of the 2 outlets are good with somewhat larger amounts of mucous secretion from the larger stoma of the intussuscepted ileal nipple.     

Physiology: evacuation, pelvic floor and continence mechanisms

Faecal continence is defined by the ability to perceive, retain and evacuate bowel contents at socially convenient times. This is reliant upon normal function of the main involved organs (i.e. rectum, pelvic floor and anal sphincters) together with their associated sensorineural pathways. Incontinence may occur as a result of dysfunction in any one of these systems or due to factors such as systemic disease, emotion, bowel motility and stool consistency. The act of defaecation is a conscious process that involves interplay between motor and sensory elements, initiated by higher cortical function.Incontinence and evacuatory dysfunction are investigated using specialized tests that assess sphincter function and structure (anorectal manometry, endoanal ultrasound), anorectal and pelvic floor function (defaecating proctography, nerve conduction studies) and luminal integrity and colonic function (transit studies and endoscopy).     

The mechanisms of continence in the Indiana pouch: a video-urodynamic study

The ileocecal reservoir (Indiana pouch) is a large volume, low pressure continent reservoir well suited for urinary diversion. The mechanism of continence is believed to be the result of several factors, including the natural ileocecal valve resistance, resistance produced by the plication of the ileal segment and normal peristalsis of the ileum. We report the results of a video-urodynamic study in patients with an Indiana pouch, aimed at establishing the factors that contribute to continence and their relative significance. Video-urodynamic studies clearly demonstrate that continence in this type of urinary reservoir is dependent upon a synergism of the aforementioned factors in combination with the low intraluminal pressure of the detubularized bowel. Video-urodynamic studies offer an objective demonstration of the reservoir dynamics and its continence mechanisms, and provide an insight into the possible etiology of incontinence. Such studies also offer an objective means for critical comparison of the different continent urinary reservoirs.     

Functional characteristics of the continent ileocecal urinary reservoir: mechanisms of urinary continence

We evaluated urodynamically 14 patients with a continent ileocecal urinary reservoir. Reservoirs were constructed of detubularized right colon alone (4 patients), or augmented with ileum (2) or with a U-shaped ileal patch (8). All reservoirs were placed in the abdomen and used plicated terminal ileum as the efferent continence mechanism. Twelve patients are completely continent with intermittent catheterization at 4 to 8-hour intervals. Two patients suffer mild nighttime incontinence. Mean reservoir volume was 675 ml. Intermittent intestinal contractions were noted in the plicated ileal segment and reservoir but they occurred more frequently in the former and were either synchronous with or preceded those in the reservoir. Mean and maximal contraction pressures were 24 and 47 cm. water, respectively, in the reservoir and 40 and 151 cm. water, respectively, in the plicated ileal segment (p equals 0.043 and less than 0.001, respectively). The highest reservoir contractions occurred in the 2 patients with nocturnal incontinence. The method of construction bore no consistent correlation with mean or maximal contraction pressures, contraction frequency or continence. Careful urodynamic assessment suggests that the ileocecal urinary reservoir is a relatively low pressure, nonrefluxing and continent bladder substitute. The plicated terminal ileal segment acts as an effective sphincter that responds to pressure elevations in the reservoir. Its simple construction and easy catheterization make it an attractive alternative to intussuscepted ileal segments.     

Microsurgery of the appendix testis (experimental research)

Based on their own experience with 83 reconstructive microsurgeries performed for epididymis obstruction the authors concluded that a simple incorporation of microsurgical techniques into the surgery of excretory infertility failed to substantially improve the results of the treatment. Supposing a well-managed clinical study to be the main tool to provide better results and the data of animal studies to be inapplicable for the diseases of the human reproductive system, the authors suggested that the aforementioned study in the clinical settings should conform to the two major requirements: an uniform pattern of the techniques employed and an exacting control over anastomosis application. As a method of choice, end-to-side vasoepididymostomy was offered. A training model for gaining the mastery of epididymis microsurgery techniques was developed as well. The reliability of the method was proved by experiments on 20 rabbits. 17 animals gave offsprings. The system of epididymal ducts studied in health opened the possibility of a well-founded division of epididymis into zones of surgical importance.     

盲肠腔内阑尾1例

1　病例报告患者　男,25岁。因转移性右下腹痛6ｈ入院。体查:体温378℃,脉搏90次/ｍｉｎ,腹平软,麦氏点压痛。白细胞:125×109/Ｌ,中性粒细胞087。Ｂ超:阑尾未显示。诊断:急性阑尾炎。入院后即在硬膜外麻醉下手术。术中于正常盲肠部位未见阑尾,切开侧腹膜完全游离盲肠后亦...     

阑尾重复畸形1例

患者　男 ,6 5岁。因转移性右下腹痛伴恶心呕吐发热 2ｄ入院。体查 :体温 38℃ ,脉博 88次 ｍｉｎ ,腹平 ,右下腹压痛 ,反跳痛 ,局限性肌紧张 ,未触及包块。白细胞 10 6×10 9 Ｌ ,中性粒细胞 0 89。诊断 :慢性阑尾炎。患者要求手术治疗。术中见大网膜包裹右下腹 ,回盲部与周围粘连紧密 ,阑尾肿大成团 ,与　　 收稿日期 :1999 10 19。　　 作者简介 :董军华 ( 1974 ) ,女 ,河北邢台人 ,河北省刑台市第三人民医院住院医师 ,主要从事病理研究工作。周围粘连 ,遂逆行切除阑尾 ,并送病理检查。病理检查 :阑尾标本长 5 5ｃｍ ,直径 1 8～ 2 …