BAPS PaperBladder augmentation in anuric/defunctioned microbladders and a novel antireflux mechanism for Mitrofanoff anastomosis to the ileal patch

Background/PurposeReconstruction of microbladders is a difficult surgical challenge: How can a neobladder be recreated when > 90% of the new bladder is augmented patch, and how can a Mitrofanoff conduit be anastomosed when the native bladder is so tiny? This series describes microbladders secondary to anuria and/or diversion that required augmentation. This was done using a de-tubularized ileal segment, and because of the small size of the native bladder, Mitrofanoff anastomosis was performed to the bowel patch (using a novel “Keel Procedure”).MethodsOur surgical experience in reconstruction of microbladders was reviewed: pre and post augmentation capacity, compliance and maximum detrusor pressure were compared. The success of the Mitrofanoff anti-reflux technique is described. Data are given as median (interquartile range) and compared by Wilcoxon paired rank test.Results10 patients, median bladder capacity pre-op 10 (9-20) mls were reconstructed. The follow up time is 2.7 years (2.2-4.2). Post-op bladder capacity increased 16-fold to 167 (114-281) mls, P < 0.01. Compliance significantly improved from 1.7 (0.3-4.8) to 14.3 (4.1-66.3) mls/cmH2O, P < 0.05. Maximum detrusor over-activity decreased from 27 (7-120) to 12.5 (8-26) cmH2O, (N.S. P = 0.3).Videourodynamics confirmed a leak in 2 patients, leading to incorporation into the technique of a non-absorbable seromuscular suture to provide long-term robustness to the antireflux procedure.ConclusionBladder augmentation in microbladders is possible, and a functional Mitrofanoff procedure with a continent anti-reflux procedure can be created using the “Birmingham keel technique” implanting the Mitrofanoff into the augment patch, with 80% success (similar to published results for conventional anastomosis to native bladders).Level of evidenceLevel IV.