Aim of Study:
Shanfield first described a simple ureteric implantation technique involving a U-stitch anchoring the spatulated end of the transplant ureter to the interior of the intact bladder through a small stab wound. Herein, we present an extrapolation of this principle to Mitrofanoff channels and native ureteric reimplantations and further extend that to the setting of a laparoscopic approach in select patients.
A total of 15 patients (8months-15 years, median 6, 9 girls, 6 boys) underwent a drop-in Shanfield anastomosis for ureteric(n=3) or Mitrofanoff(n=12) implantation into the bladder. Diagnoses: VUR(n=2), VUJ obstruction(n=1), Neuropathic bladder(n=4), Exstrophy (n=2,Bladder=1,Cloacal=1), Non-neuropathic bladder(n=3), Cloaca(n=2) and one with failed urethral reconstruction of a xY-duplication. Two ureteric reimplantations and one appendix-Mitrofanoff were undertaken entirely laparoscopically. In 9/15, the bladder was not opened, the remaining 6 was in the setting of an ileo-cystoplasy and one complex cloaca. Case notes were reviewed with special emphasis on complications related to the bladder end of the conduit.
Fourteen patients were available for follow-up (5.8–43.3months, median18.2). There was no anastomotic leakage in any. In one, stenosis was successfully managed with simple dilatation, while one complex patient required a new Mitrofanoff channel.
Our preliminary data suggest that the Shanfield anastomosis offers a safe, robust and simple antireflux implantation technique without the need to formally open the bladder. The technique offers several advantages as it allows overcoming the problem of inadequate tunnelling when the bladder template is deficient; meanwhile its simplicity permits it to be faithfully reproduced with laparoscopy in a select set of patients.