Case 17—Operative Report Preoperative Diagnosis: Neurogenic bladder,

Case 17—Operative Report Preoperative Diagnosis: Neurogenic bladder, status post Mitrofanoff and bladder augmentation with difficulty catheterizing Mitrofanoff Postoperative Diagnosis: Mitrofanoff stenosis at the reimplant portion Operation: Cystoscopy per Mitrofanoff and fulguration of Mitrofanoff channel and catheterization Anesthesia: LMA Indication: This is an 8-year-old girl with a history of spina bifida with neurogenic bowel and bladder. The patient is status post bladder augmentation and Mitrofanoff and appendiceal ACE. The patient had a Mitrofanoff revision last March and is still having difficulty inserting her catheter. The patient has had to have an indwelling catheter per her Mitrofanoff in the past several months. Findings: On cystoscopy the patient had a dilated distal Mitrofanoff channel from the umbilicus down to her reimplant portion. There was a stenotic region at approximately 6 o’clock at the insertion into the bladder. The bladder appeared to have good capacity and no stones or tumor were noted. Bilateral ureteral orifices were visualized with reflux of clear urine. Procedure: The patient was intubated by anesthesia and given IV Kefzol. The patient was placed in the supine position, prepared and draped in usual sterile fashion. The Mitrofanoff channel was dilated with 12 French van Buren sounds. A 12 French cystoscope with 30-degree lens was used for intubation of the umbilicus per her Mitrofanoff channel, and we subsequently entered the bladder. Formal cystoscopy and evaluation of the Mitrofanoff under direct vision was performed. The patient had stenosis at the 6 o’clock region of her Mitrofanoff reimplant to the bladder. A 3 French Bugbee cautery set at 55 watts was used to cut this lip at 6 o’clock in her Mitrofanoff in the reimplant portion. The reimplanted region appeared to open up easily and was capacious. Cautery was then used to cauterize loose mucosa in the Mitrofanoff region at 55 watts. Good hemostasis was present. The cystoscope sheath was subsequently removed and a 12 French silicone catheter was inserted without any problems into the bladder. The bladder was subsequently emptied and irrigated. The patient was extubated and sent in stable condition to the recovery room. Case 17 Code(s): _____________________________ SCIENCE

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