Aim of Study:
Shanfield(1972) first described a simple 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 (Transplantation Proceedings 4:637,1972). Herein, we present an extrapolation of this principle to Mitrofanoff channels, ureteric re-implantations and in the setting of a laparoscopic approach for some.
A total of 15 patients (8months-14years,median-6, 9-girls, 6-boys) underwent a Shanfield anastomosis for ureteric(n=3) or Mitrofanoff(n=11) implantation into the bladder. A tunnelled anti-reflux mechanism was created by extramucosal detrusorotomy or submucosal dissection. Diagnoses: VUR(n=2), VUJ obstruction(n=1, Laparoscopic), Neuropathic bladder(n=4), Exstrophy (n=2,Bladder=1 and Cloacal=1), Non-neuropathic bladder(n=3), Cloaca(n=2) and one with failed urethral reconstruction of Y-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 (3.3-34.3months, median-11months). There was no anastomotic leakage. In one, stenosis was successfully managed with simple dilatation. One with ileo-cystoplasty developed subsequent leakage through the channel, however had inconclusive urodynamics.
Our preliminary data suggest that the Shanfield anastomosis offers a robust and simple implantation technique without the need to formally open the bladder. Catheterisation of the conduit is easy and reliable as there is no mucosa to mucosal anastomosis/junction to negotiate. This technique also simplifies the laparoscopic approach.