Grzegorz Kudela, Tomasz Koszutski, Wojciech Utrata, Mirosław Mikosiński, Janusz Bohosiewicz

VQZ-plasty for Mitrofanoff and Malone stoma

Department of Paediatric Surgery and Urology,

Upper-Silesian Centre for Child’s Health, Katowice, Poland

Konferenci dětských urologů, nefrologů a pediatrů

Kurdějov , 2014

Major advances in the neurogenic bladder treatment

• 1972 – Jack Lapides – clean intermitent catheterizationLapides J, Diokno AC, Silber SJ, Lowe BS: Clean, intermittent self-catheterization in the treatment of urinary tract disease. J.Urol 1972; 107: 458-61.

• 1980 – Paul Mitrofanoff – continent vesico-appendicular stoma for self-catheterizationMitrofanoff P. Cystostomie continent trans-appendiculaire dansle traitement des vessies neurologiques.

Chir Pediatr. 1980; 21: 297-305

• 1990 – Padraig Malone – continent coeco-appendicular stoma for antegrade enemaMalone PS, Ransley PG, KielyEM. Preliminary report: the antegrade continence enema. Lancet 1990; 336: 1217-8

Traditional sides of stoma: - umbilicus- right lower quadrant

* simple connection to the skin* skin V-flap connected to incised appendix

Complications (literature):- Stenosis up to 45 %- Unaestetic eversion of the mucosa

Our experience - complications - 15 children in 2002-2009 (before VQZ-plasty)

No:Complete occlusion of the stoma 3Stoma perforation 1Stenosis of the stoma/reoperation 2 Unaestetic eversion of the mucosa 5General 11

VQZ techniqueP.G. Ransley The “VQZ” plasty for catheterizable stomas in J.D. Frank, J.P.

Gearhart, H.M. Snyder III (Eds.), Operative Pediatric Urology (2nd ed.), Churchill

Livingstone, London (2002), pp. 109–114

G.Kudela et al.:. Problemy Chirurgii Dziecięcej 2013,t3, 37-41

VQZ plasty

VQZ plasty

VQZ plasty

VQZ plasty

VQZ plasty

Our material - 2010-2013

• 16 children (12 girls and 4 boys)

• Age 12-17 years.

• Procedures:- Mitrofanoff stoma - 3 - Malone stoma - 2 - simultaneous Mitrofanoff and Malone - 5- bladder autoaugmentation and Mitrofanoff - 2 - bladder autoaugmentation, Mitrofanoff and Malone - 1- ileocystoplasty and Mitrofanoff - 1- antireflux procedure + Mitrofanoff - 1- Mitrofanoff stoma + bladder neck plasty (Pippi-Sally) - 1

Mitrofanoff & Malone.

Mitrofanoff & Malone.

• Mitrofanoff - umbilicus & Malone - VQZ plasty.

• After procedure – catheters were left in stoma for 6 weeks – after it intermittent catheterization was started.

Cosmetic result

Cosmetic result

Results:

• Stomal stenosis – 1

• Visible mucosal eversion – 1

• All patients are able to self-catheterize appendicular stoma

Conclusion

The use of VQZ-plasty is associated with a lowrisk of complications and a good cosmetic effect.

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