Appendicovesicostomy in children

The treatment of bladder dysfunction is based on bladder drainage to maintain low pressure in the bladder and protect the upper urinary tract. Mitrofannof's continental bladder diversion technique is an alternative treatment, in which a thin tube (appendix) is inserted between the skin and the bladder to allow catheterization. In most cases, it is combined with a bladder neck closure and an enlargement enterocystoplasty. Postoperatively, a Ch. 12 bladder catheter, passing through the appendix, is left in place for around 2 weeks, after which catheterization is initiated. Continence achieved with this technique is over 90% in most series. Complications, which may be noted during follow-up, are mainly the occurrence of significant leaks, stenoses, especially at the level of the cutaneous orifice, requiring surgical revision rather than simple dilatations, which frequently fail, urinary tract infections and bladder lithiasis. Hence the importance of clinical, biological and ultrasound follow-up.