# Ureteral versus appendiceal Mitrofanoff channels: a retrospective analysis of functional outcomes and complications

## TL;DR

This study compares the use of ureteral and appendiceal Mitrofanoff channels for urinary diversion, finding similar continence outcomes but different complication rates.

## Contribution

The study provides a novel comparison of ureteral versus appendiceal Mitrofanoff channels in patients with nonfunctioning kidneys.

## Key findings

- Ureteral Mitrofanoff channels showed comparable continence outcomes to appendiceal channels.
- Stomal stenosis was more common in appendiceal channels, while meatal granuloma was more frequent in ureteral channels.
- Both types of channels had similar rates of other complications like urine leakage and catheterization difficulty.

## Abstract

The Mitrofanoff principal entails creating a continent catheterizable channel, traditionally the appendix. In patients with nonfunctioning kidney, the ureter of this kidney can be an alternative This study aims to compare outcomes of ureter versus appendiceal Mitrofanoff channels (MCs).

We retrospectively reviewed patients who underwent MC creation between January 2020 and June 2024 for patients with neurogenic bladder, exstrophy–epispadias complex, prune belly syndrome, or posterior urethral valves. Group A included patients who had a ureter as MC (n = 11), while Group B included those with an appendiceal MC (n = 33). Data on demographics, operative details, complications, and continence outcomes were collected and analyzed.

Forty-four patients (Male patients = 24) were included, with a median age of 13.0 years (IQR 9.0–15.0) in Group A and 10.0 years (IQR 7.0–12.0) in Group B (p = 0.002). Myelomeningocele was the most common diagnosis in both groups. Bladder augmentation was performed in 81.8% of patients in each group, predominantly with ileo-cystoplasty. Satisfactory clean intermittent catheterization (CIC) without complications was achieved in 54.4% of Group A and 57.5% of Group B. Stomal stenosis occurred more frequently in Group B (18.2% vs. 9.1%, p = 0.003), while meatal granuloma was more common in Group A (27.3% vs. 9.1%, p = 0.043). Other complications included urine leakage, painful catheterization, catheterization difficulty, and intestinal obstruction, with no significant intergroup differences.

Ureter as an MC offers a valid option for continent urinary diversion, demonstrating comparable continence outcomes as compared to appendiceal MC. The ureter represents a feasible and reliable alternative conduit in patients with a nonfunctioning kidney.