Innovative Urology Procedure Helps Kids in Wheelchairs

Madison, Wisconsin - Children who live their lives in a wheelchair due to birth defects, neurological damage or spinal injuries not only have to accept their inability to walk. They also have to deal with bladder and bowel control problems.


Surgeons at American Family Children's Hospital are using two innovative procedures to improve such children's quality-of-life and ability to take part in social activities.


Dr. John V. Kryger, a urologist at American Family Children's Hospital, is performing the Mitrofanoff procedure on children. The surgery, named after French surgeon Paul Mitrofanoff, involves connecting a piece of intestine from the child's navel to the bladder.


"All they have to do is lift up their shirt, pass a tube through the belly button into the bladder and drain their bladder into a toilet or receptacle," he says. "If these children can't empty their bladders, the pressure from excess urine build-up can lead to kidney damage and kidney infections that can shorten a child's life."


Kryger says the procedure is more convenient than using catheters attached to the child's private parts to drain urine from the bladder.


"If you are in a wheelchair, you have to undress and lie down," he says. "That's very challenging when you are going to school. This procedure helps the child achieve greater independence, especially if they have weak muscle tone or motor skills."


Another surgery called the Malone Antegrade Continent Enema, or MACE, is aimed at reducing constipation and its associated problems. In this procedure, a section of intestine is installed from a passageway in the abdomen into the colon.


"The procedure is better than enemas that clear out only a small portion of the rectum, or colostomies that allow stool to be emptied into a bag," he says. "We create a channel to the colon of the patient, who sits on the toilet and flushes out the colon using a catheter connected to a bag of water. Patients need to do this every other day for 30 to 60 minutes at a time."


Kryger says everyone is a candidate for these procedures, and some patients are as young as 5 years old. Most children are hospitalized for a week and back in school after another week of recovery. However, not every parent may consider it the best option for their child.


"Some families don't want to make the commitment of catheterizing everyday," he says. "They are offered alternatives such as diverting waste from bladder and bowels into a bag."


But, overall, Kryger says patients who have undergone these surgeries have improved their lifestyles and increased their confidence.


"It used to be children didn't want to go to school because they were constantly teased about their diapers and the smell of urine and feces," he says. "After having these procedures to give them greater bladder and bowel control, these kids eventually performed well in school, went to college, had relationships and started careers."

Date Published: 04/19/2011

News tag(s):  childrenjohn v kryger

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