Urethral Sheath to Evacuate Blood Clots through Mitrofanoff Appendicovesicostomy

Abstract

Background: the Mitrofanoff appendicovesicostomy provides a catheterizable submucosal tunnel between umbilicus and bladder (or neobladder). In patients with a closed bladder neck, the Mitrofanoff channel is the only way to access the bladder. We describe our case of a 17 year-old girl with a Mitrofanoff appendicovesicostomy and a previous surgical closure of the bladder neck and who developed a large bladder clot due to hematuria after a surgical cystolithotomy in an augmented bladder; Methods: after an unsuccessful trans-appendicovesicostomy bladder washing, the endoscopic evaluation was performed using a 14 Ch rigid cystoscope and surrounded by its own urethral sheath. The clot was progressively fragmented through the cystoscope under direct vision. Clot fragments were aspirated to obtain a complete evacuation; Results: the urethral sheath prevented damages to the appendicovesicostomy, allowing at the same time repeated accesses of the cystoscope into the neobladder and ensuring the procedural success. The postoperative period was uneventful, and the neobladder catheter was removed after two days. Neither channel stenosis nor anastomosis dehiscence nor incontinence were reported after five months; Conclusions: the use of urethral sheath 14 Ch through an appendicovesicostomy preserves both the stoma and the channel, making possible endoscopic procedures such as blood clot evacuation into the neobladder.