1190 MODIFIED ABDOMINOPLASTY IN PRUNE BELLY SYNDROME: TECHNIQUE AND RESULTS IN A LARGE COHORT OF PATIENTS

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THE JOURNAL OF UROLOGY姞

urothelium completely covered the de-mucosalized gastric flaps in Groups IV and V. Although all stomach flap grafts contracted ten weeks after surgery, the stomach grafts in Groups I and V showed less contraction (half the original size). In contrast, the stomach grafts in Groups II, III, and IV significantly contracted to one quarter of the original size. CONCLUSIONS: Bladder cell-seeded SIS promotes complete urothelial regeneration on demucosalized stomach flap grafts. Botox A injection appears to protect the graft from contraction. Combination both of these techniques has a potential clinical use in bladder reconstruction via gastrocystoplasty. Source of Funding: None

1190 MODIFIED ABDOMINOPLASTY IN PRUNE BELLY SYNDROME: TECHNIQUE AND RESULTS IN A LARGE COHORT OF PATIENTS Francisco Tibor-Denes*, Alessandro Tavares, Marcos Machado, Amilcar Giron, Miguel Srougi, Sao Paulo, Brazil INTRODUCTION AND OBJECTIVES: We present the results of a modified abdominoplasty in patients with the Prune Belly Syndrome (PBS). METHODS: Since 1985, 40 PBS children underwent surgical treatment that included urinary tract reconstruction (UTR), orchidopexy and abdominoplasty. In 36 we performed the abdominoplasty as follows: 1. fusiform longitudinal ressection of the mid-abdominal skin and subcutaneous tissue, with preservation of the musculo-aponeurotic fascia (MAF) with the umbilicus, 2. ellipsoid unilateral longitudinal incision of the MAF, preferentially interesting the most weakened side of the abdomen, producing two flaps, the umbilicus being kept intact in the widest flap, 3. after UTR (including apendicular Mitrofanoff to the umbilicus in two patients) and bilateral orchipexy, suture fixation of the widest MAF layer to the inner side of the contralateral abdominal wall, creating an inner MAF layer 4. lateral suture fixation of the other flap over the inner layer, creating an outer MAF layer with a button-hole exposing the umbilicus, that is sutured to the outer layer 5. aproximation of the skin edges medially after partial undermining of both sides, with incorporation of the umbilicus in the suture. RESULTS: Skin coaptation was excelent in all patients, and no trimming was necessary in the upper and lower extremities of the incision. There was no dehiscence nor skin necrosis in any patient, and all presented immediate improvement of the abdominal tonus and appearance. Both Mitrofanoff stomas remained healthy in the followup. Further improvement with growth was observed in all except 4 patients, two requiring secondary abdominoplasties. CONCLUSIONS: We conclude that this is an excelent alternative to the Monfort technique, applicable in all forms of weakened abdomen typical of PBS, even in assymetrical cases, requiring only one MAF incision, with good cosmetic and functional results, excellent skin coaptation and no need of skin trimming at the extremities of the incision. Source of Funding: None

1191 RESULTS OF A SPLIT APPENDIX TECHNIQUE FOR CONCOMITANT CREATION OF MITROFANOFF AND MALONE CONTINENT CATHETERIZABLE CHANNELS Alice Payton*, Shumyle Alam, William Defoor, Eugene Minevich, Pramod Reddy, Paul Noh, Curtis Sheldon, Cincinnati, OH INTRODUCTION AND OBJECTIVES: Urinary tract reconstruction in children with complex urologic abnormalities can be challenging. We have previously reported the technique of splitting the appendix to create both a Mitrofanoff neo-urethra as well as a Malone anterograde continence enema. The purpose of this study is to report our experience and longterm outcomes with this technique. METHODS: A retrospective cohort study was performed of all children and young adults who underwent continent urinary reconstruction

Vol. 185, No. 4S, Supplement, Monday, May 16, 2011

who had their Mitrofanoff and Malone created using a split appendix technique at a single pediatric institution from 1990 to 2010. Patient demographics, surgical technique, complications, and clinical outcomes were abstracted from the medical record. The distal end of the appendix was used for the Mitrofanoff and was implanted into the bladder using an extravesical technique and the stoma matured in the right lower quadrant in all cases. The proximal end of the appendix was used for the Malone and the stoma was brought to either the umbilicus or right lower quadrant. RESULTS: A total of 40 patients (22 male and 18 female) were identified. Mean age at the time of reconstruction was 7.0 years and mean follow-up was 4.0 years (range 1–13 years). Diagnoses included myelomeningocele (21), anorectal malformation and cloacal anomalies (13), tethered cord and spinal cord abnormalities (6). There were no intraoperative complications or loss of the appendix due to vascular accident. Mitrofanoff outcomes included stomal stenosis in 5 patients, false passage in 2, and mild incontinence in 2. Mitrofanoff stomal revision for stenosis was required in 4 patients. Malone outcomes included stomal stenosis in 8 patients, fecal leakage in 3 patients, traumatic false passage in 2 patients, and prolapse in one patient. Revision of the Malone stoma was required in 3 patients. In addition, stenosis of the Malone was treated with topical steroids in 2 patients, dilation in 2 patients, and temporary Mic-key button placement in 1 patient. CONCLUSIONS: Creation of continent catheterizable channels for both Mitrofanoff neo-urethra and Malone can be safely and effectively performed using a split appendix technique with an extravesical reimplantation into the bladder. This avoids harvesting additional enteric tissue for purposes of a Monti-mitrofanoff or a neo-appendicostomy. A bowel anastomosis is also avoided when an augmentation is not indicated. Stomal complications are not insignificant however, and comprise the majority of complications for this procedure. Source of Funding: None

1192 POST-PUBERTAL OUTCOME AFTER DISTAL HYPOSPADIAS REPAIR IN CHILDHOOD USING THE MEATAL MOBILIZATION (MEMO) TECHNIQUE Joerg Seibold*, Maren Werther, Saladin Alloussi, Karl-Dietrich Sievert, Arnulf Stenzl, Christian Schwentner, Tuebingen, Germany INTRODUCTION AND OBJECTIVES: Meatal mobilization (MEMO) after distal urethral preparation can be used for distal hypospadias repair with or without chordee. Initial data yielded promising cosmetic and functional results. However, nothing is yet known about the postpubertal outcome, patients’ self perception and importantly sexual function. Herein, we present a cohort of patients who have reached adulthood after hypospadias repair in childhood focussing on the abovementioned items. METHODS: 286 patients who underwent glandular, coronal or subcoronal hypospadias repair using the meatal mobilization (MEMO) technique were retrospectively identified. Of those 25 are older than 18 years. This cohort was invited by phone or mail and was specifically investigated using uroflow, residual urine measurement, sexual function (IIEF) and quality of life (QoL). Finally, the so-called HOSE-score (objective hypospadias symptom score) was applied. RESULTS: All 25 patients were available for follow-up. No additional findings were documented in terms of cosmesis or fistula formation (0/25). All had a negative urine culture and no post-void residual. Uroflow-patterns were bell-shaped in all 25 men. Median HOSE-score was 15 (of maximum 16 points). All had a straight erection of the penis. IIEF-scores were normal in all men. CONCLUSIONS: Using the MEMO technique for correction of distal hypospadias, complications are minimal while the cosmetic results remain excellent over time. In the long-term follow-up no additional fistula or meatal stenosis occurred. Sexual function and quality of life after puberty are comparable to healthy age matched individuals. Source of Funding: None