An alternative channel for the Mitrofanoff principle based on transverse skin flaps: An extraperitoneal minimal invasive approach (the RPM technique)

OBJECTIVE: The Mitrofanoff principle is a well established strategy in pediatric urology, with the appendix and Yang-Monti tube being the most used channels. The search for an alternative tube with less morbidity is justified. Hence, we present a patient treated via an alternative approach in which the channel was constructed from two lower abdominal transverse skin flaps (the RPM technique). METHODS: A 17-year-old patient with posterior urethral valves, hypocontractile bladder and experiencing pain on urethral clean intermittent catheterization was selected. The procedure consisted of defining two rectangular transverse skin flaps of 5 × 1 cm opposite to each other. The flaps were rotated 90° and anastomosed to create a tube. A small extraperitoneal bladder wall incision was performed and the tube was connected to the bladder. Two rectal abdomen muscle strips were crossed in the midline as a neosphincter. RESULTS: The patient had an uneventful postoperative course and remains continent for intervals of 4 h. The stoma and incision have a good cosmetic aspect at 16 months follow-up. CONCLUSION: The RPM technique is an alternative approach for a minimal invasive strategy according to the Mitrofanoff principle. Long-term follow-up is necessary to confirm the excellent initial results.