An alternative channel for the Mitrofanoff principle based on transverse skin flaps: An extraperitoneal minimal invasive approach (the RPM technique)

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Macedo, Antonio [UNIFESP]
Rondon, Atila [UNIFESP]
Bacelar, Herick [UNIFESP]
Leslie, Bruno [UNIFESP]
Ottoni, Sergio [UNIFESP]
Liguori, Riberto [UNIFESP]
Garrone, Gilmar [UNIFESP]
Ortiz, Valdemar [UNIFESP]
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Objective: the Mitrofanoff principle is a well established strategy in pediatric urology, with the appendix and Yang-Monti tube being the most used channels. the search for an alternative tube with less morbidity is justified. Hence, we present a patient treated via an alternative approach in which the channel was constructed from two lower abdominal transverse skin flaps (the RPM technique).Methods: A 17-year-old patient with posterior urethral valves, hypocontractile bladder and experiencing pain on urethral clean intermittent catheterization was selected. the procedure consisted of defining two rectangular transverse skin flaps of 5 x 1 cm opposite to each other. the flaps were rotated 90 degrees and anastomosed to create a tube. A small extraperitoneal bladder wall incision was performed and the tube was connected to the bladder. Two rectal abdomen muscle strips were crossed in the midline as a neosphincter.Results: the patient had an uneventful postoperative course and remains continent for intervals of 4 h. the stoma and incision have a good cosmetic aspect at 16 months follow-up.Conclusion: the RPM technique is an alternative approach for a minimal invasive strategy according to the Mitrofanoff principle. Long-term follow-up is necessary to confirm the excellent initial results. (C) 2012 Journal of Pediatric Urology Company. Published by Elsevier B.V. All rights reserved.
Journal of Pediatric Urology. Oxford: Elsevier B.V., v. 8, n. 4, 2 p., 2012.