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Oral Presentation - 29
EFFECT OF MITROFANOFF ON RENAL FUNCTION AND OUR EXPERIENCE WITH SILS ASSISTED MITROFANOFF PROCEDURE WITHOUT BLADDER AUGMENTATION
M Attar*, E Raboe**, A Alsaggaf**, A Zeinelabdeen**, M Zydan**, A Alawi**, M Fayez**, Y Owiwi**, A Atta**, S Al Ghamdi**, H Nasser*, A Ghallab**, S Al Razgan*
*King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia Pediatric Nephrology
**King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia Pediatric Surgery
Aim: To evaluate the efficacy of Mitrofanoff procedure in terms of improved renal function, reduced hydronephrosis and recurrent urinary tract infection (RUTI)
Patients & Methods: Retrospective review of all patients on clean intermittent catheterization (CIC) with Mitrofanoff were studied from 2007 to 2017. Procedures options were Mitrofanoff alone in 11patients, Mitrofanoff plus bladder augmentation in 5 patients, and Mitrofanoff + bladder augmentation + other procedures in 10 patients. The outcome of CIC on serum urea and creatinine, glomerular filtration rate (GFR), severity of hydronephrosis and frequency of UTI was evaluated. Mean follow up was 6 years range 1-16 years
Results: Twenty six patients were evaluated in this study. Fifteen boys and Eleven girls. One was missed from follow up and one has chronic kidney disease with GFR<15 ml/min/1.73m2 from start. The indications for Mitrofanoff were obstructive uropathy, meningomyelocele, Prune Belly syndrome and bladder extrophy. Fourteen patients have good results with decreased or stabilized level of serum urea and creatinine, improvement of GFR in patients with GFR >30ml/min/1.73m2. No change in patients with GFR >15ml/min/1,73m2. Improvements of hydronephrosis especially in patients with moderate to severe degree was confirmed by US. The frequency of UTI was decreased in the follow up period.
Conclusion: Mitrofanoff principle can protect upper urinary tract in the long term. One patient with GFR< 30 deteriorated after one year of follow up, so early diagnosis, assessment of bladder dysfunction and early intervention is recommended. Although the sample is small, most of the patients demonstrated improvement or stabilization in renal status. Although bladder augmentation were done in half of the patients but still it wouldn't affect the outcome alone without CIC. Further prospective research on continent urinary diversion with large sample size focusing on renal outcome in children and the best measure for follow up are recommended.