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Thread: A procedure to make a bladder-abdomenal wall conduit using part of the bladder wall.

  1. #1

    A procedure to make a bladder-abdomenal wall conduit using part of the bladder wall.

    I recent met two spinal-injured women at a meeting in Ipsilanti Michigan. They described a urinary diversion procedure that I had not seen before and appears to be working very well for them. As many of you know, a mitrafanoff is a procedure where the appendix is used as a conduit between the bladder and the umbilicus (belly button), allowing people to catheterize themselves through the conduit instead of through the urethra. This not only significantly reduces urinary infections but also allows people, particularly quadriplegic women, to catheterize themselves easily and often improves the quality of life.

    If the appendix is not big or long long enough, the surgeons sometimes have to use a piece of the intestine (called ileum) or colon as the conduit. Intestines, however, tend to produce mucus. This is often troublesome and can cause mucus plugs and requires flushing.

    This new procedure (I don't its name but perhaps it should be called continent cutaneous vesico-vesicostomy) uses part of the bladder wall to create the conduit. This procedure is not for everybody because it requires that the bladder be of sufficient size for part of the bladder wall to be used as a conduit. The conduit goes from the bladder to the lower midline or right lower abdomen. The patients who had this procedure expressed a lot of satisfaction with the procedure and told me that it has changed their lives for the better. They also told me that they have had no problem with mucus and that surgeon made the valve opening to the stomach wall so that it would leak if the bladder pressure is too high, providing a safety valve for people with severe spasticity.

    This procedure is done by Dr. McGuire at the University of Michigan in Ann Arbor. He has apparently done about 90 cases. I was unable to find a publication by Dr. McGuire from Michigan on this subject in Medline and will continue to look for it.

    Wise.

  2. #2
    The book that I got to take home says the procedure I am getting is the Continent Urinary Reservoir. I'm not sure if this is the same procedure the doc in Michigan is using. The belly button is usually used for the stoma, but if it cannot be used it will be placed elseware. With the CUR a portion of the bowel or stomach will used to construct the urinary reservoir.

    With the CUR procedure there is still mucus and the bladder must be flushed AT LEAST once a day with saline. From what my doctor said it's not much different than the Mitrafanoff except they have had better results with this lasting longer. He explained that the bladder was like a tire. The appendix was used to make it bigger as a patch and sometimes that patch wears out. He was not against the Mitrafanoff, but this is the method he uses. He is also a Pediatric Urologist so I watched the take home video and saw three kids do everything with no problems.

    If you have any questions on anything in my book or about this procedure I can try and answer them.

    ~I now contain-with this new curiosity, with this flaming capacity to care once more, with reborn capacity to sing-I now contain the awful capacity to want and to love.~ Anne Rice

  3. #3
    Kristi: the CUR procedure is done when the bladder, for medical reasons, needs to be removed. It's not the same thing that Dr. Young is describing.

    RAB

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