Outcomes of urinary diversion in children with spinal cord injuries

Purpose: To gain a better understanding of the outcomes of the Mitrofanoff procedure for urinary diversion in children with spinal cord injury (SCI). Design: Descriptive retrospective. Participants/Methods: Individuals 6 to 27 years of age with SCI with at least 1 year follow-up after the Mitrofanoff procedure. Objective data collected via retrospective chart review include general demographics and medical/surgical history. Data collected via structured telephone interview include history of adverse urological events, bladder management, bladder management independence scores, patient satisfaction, and quality of life. Results: Sixteen subjects (13 female, 3 male) with a mean age of 19 years (range 6-27 y) who underwent the Mitrofanoff procedure were interviewed. Length of postoperative follow-up ranged from 1 to 8 years (mean 4.25 y). Complications included stomal stenosis 25% (n = 4) with a mean of 19 months to first occurrence of stenosis; urethral incontinence 75% (n = 12); renal/bladder calculi 19% (n = 3); and stomal leakage 44% (n = 7). Independence scores for bladder management after the Mitrofanoff procedure improved in 84% of subjects with tetraplegia and 25% of subjects with paraplegia. Eighty-eight percent (n = 14) were satisfied with the procedure, while 12% (n = 2) were somewhat satisfied. A thematic analysis of quality of life revealed that freedom (35%) and independence (35%) were most commonly cited. Conclusion: While some subjects experienced complications, satisfaction was relatively high and level of independence in bladder management was greatly improved. This study demonstrates that the Mitrofanoff procedure is a beneficial option to improve independence and ease of bladder management in children with SCI.