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Professor Paul Mitrofanoff created the Mitrofanoff (mi-trof-fan-off) procedure in 1976, also known as the Mitrofanoff Appendiciovesicostomy or a Continent Urinary Diversion. The Mitrofanoff was introduced to permit bladder drainage where voiding or urethral self-catheterisation is not possible. For a patient the procedure enables them to maintain dignity and means that there is no need to have an indwelling catheter or wear a stoma bag.
The purpose of this operation is to form a channel between the bladder and the wall of the abdomen to allow intermittent self-catheterisation ie, drainage of the bladder. The Mitrofanoff is preferentially made from the appendix (or small bowel) which is mobilised on its blood supply or a piece of bowel, this can also be achieved with a fallopian tube. One end is tunnelled into the wall of the bladder to create a valve that acts as a continent mechanism, the other end is passed through an opening in the abdominal wall to form a small stoma through which a catheter can pass to empty the bladder 4-6 times a day.
The Mitrofanoff is often situated on the right hand side of the lower abdomen, just below the underwear line or for cosmetic appearances another possible site is the umbilicus.
The procedure may be an option due to the following conditions:
This procedure is frequently carried out in conjunction with other procedures where satisfactory voiding function may not be possible.
When creating an augmented or a neo bladder low pressure must be ensured to and protect the kidneys from back pressure.
If you have your native bladder you may not need the following regularly:
Stenosis is when narrowing of the channel occurs. If the channel becomes narrow the first step would be to leave a catheter in situ for one week. If narrowing continues you may be required to undergo a revision and in some cases more significant surgery.
Leaking can occur via the stoma which can be due to a non-functioning valve, a small bladder or high pressure bladder. This can be assessed by a non invasive test called urodynamics.
Stones can be produced within the bladder when the bladder is not fully drained and there is incomplete emptying. Due to the type of tissue used for a Mitrofanoff, bladder augmentation or neo bladder there will be a build up of mucus within the urine, which can also create stones.
Infections can develop when there is low fluid input to flush the kidneys and bladder, this is why drinking is vital. Urinary tract infections can also occur when the bladder is not fully drained and incomplete emptying of all the bugs the bladder produces. Poor personal, hand and catheter hygiene can also result in infections.
All procedures and surgery come with risks and complications, the Mitrofanoff procedure may not be suitable or successful in some cases.
The Mitrofanoff procedure can be a long-term solution to enable patients to maintain a normal quality of life and dignity.
Medical information for children & teens click here http://www.mitrofanoffsupport.org.uk/so-you-might-need-a-mitrofanoff/