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Appendix or Ileum - Which is the Best Material for Mitrofanoff Channel Formation in Adults?

INTRODUCTION
We report the long-term data of a large adult cohort undergoing formation of a continent catheterisable channel for a variety of indications. We aim to examine outcomes according to tissue used for channel formation.


METHODS
We performed a retrospective case note review of 176 consecutive adult patients having creation of a continent catheterisable channel using the Mitrofanoff principle for a broad range of indications a median of 142 months (range 54-386) ago. We evaluated outcomes in terms of continued use and continence for each type of material used for channel formation.


RESULTS
At the time of this review, 165 (95.4%) out of 173 patients included in this study were alive. We included 114 (65.9%) women and 59 (34.1%) men who underwent surgery at a median age of 42 years (range 18-73) with a mean (median, range) follow up of 78.6 months (60, 2-365). Revision rates for all causes were higher in the ileal group compared to those with appendiceal channels (17.2% appendix v 22.7% ileal, p = 0.39 for channel stenosis and 19.5% appendix v 36.0% ileal, p = 0.03 for incontinence). Despite 38.7% of patients undergoing major surgical revision of their channel at some point, 75.9% of channels continue to be used and of these 90.2% are continent.


CONCLUSION
This study provides a pragmatic overview of the outcome of these challenging patients. Mitrofanoff channel formation represents a durable technique. Both appendix and ileum are viable choices for tissue use and tissue selection will depend on availability and individual patient factors.