The Mitrofanoff procedure creates a new tube on a child’s belly through which a child can urinate (pee) by using a catheter (putting a small tube into the new tube). The new tube is made from the appendix. It connects the bladder to a small hole created in the belly button or in an area in the lower belly. This way, children can empty their bladders by catheterizing through the new tube instead of using the urethra (the tube that pee normally goes through when it leaves the body).
During the surgery, the appendix is cut away from the intestine but not from its blood supply. The surgeon sews one end of the appendix to the back side of the bladder. The other end of the appendix is then pulled up and attached to the belly. A small hole is made on each end of the new tube (one on the belly or in the belly button, one in the bladder) so that children can put in a catheter through the opening on their belly or belly button to empty the bladder.
There are two possible ways the surgery may be done:
- Open surgery - A small cut (a couple of centimeters wide) is made in the lower belly. The skin is pulled aside so the surgeon can see and work directly on the child. This is the only surgical technique used in many hospitals. However, Nationwide Children’s Hospital reserves open surgery only for patients who are not good candidates for minimally invasive surgery.
- Robotic surgery – Several tiny cuts (several millimeters wide) are made in the belly. The surgeon uses a computer to control the robotic arms, which move small tools underneath the skin to do the operation.
The Mitrofanoff procedure is often done at the same time as other operations. When this is the case, surgeons at Nationwide Children’s will try to use the same cuts for all of the procedures. This may speed healing and keep pain and scarring to a minimum.
Why Is the Mitrofanoff Procedure Done?
The Mitrofanoff procedure is done for children who can not urinate on their own. Many of these children use traditional catheters before surgery. These catheters are inserted through the urethra, the normal place pee exits the body. However, catheters through the urethra can cause pain in boys and may be difficult for girls to put in because of their anatomy. Girls who use wheelchairs are often not able to put in a catheter unless they sit on a toilet, which can make them less independent.
In some cases, children for whom it is difficult to catheterize through the urethra may stay in diapers. In others, the sphincter muscles do not work well and the child continues to leak into a diaper. Diapers can become socially uncomfortable for children as they age. The smell of urine and its impact on the skin and any wounds in the diaper area can lead to low quality of life.
After a Mitrofanoff procedure, children can empty their bladders without diapers, without needing to transfer to a toilet, and without catheterizing through the urethra. This makes it easier and more comfortable for many children to empty their bladders. They can stay dry between catheterizations. In the case of many wheelchair users, it allows more independence, since children can catheterize themselves through the opening on their belly or in their belly button.
Mitrofanoff procedures are often done for children with:
- Spina bifida and myelomeningocele
- Spinal cord injuries
- Neurogenic bladder or non-neurogenic neurogenic bladder (Hinman syndrome)
How to Prepare for the Mitrofanoff Procedure
The Mitrofanoff procedure is not an emergency surgery. You will schedule the operation in advance. A nurse from Nationwide Children’s will call 1-3 days before the operation to give instructions. Mitrofanoff procedures require a stay of 4 to 7 days at the hospital.
If your child has constipation problems, or is undergoing robot-assisted surgery or multiple operations at the same time, he or she will need to arrive a day before the scheduled surgery to help clean out their bowels.
What to Expect at the Hospital
- Early admission and bowel prep are not required for every child. However, if your child needs to arrive a day early, your child will start a liquid diet at the hospital to help clean out the bowels in time for surgery. This bowel prep may include a feeding tube or enema. This gives more room for the surgeon to work inside the belly.
- No matter what surgery technique is being done, your child will have to stop eating and drinking by midnight the night before the surgery.
- Early the next morning, your child will be put to sleep for the operation using medicine (general anesthesia).
- Your child will be given at least one dose of antibiotics through an IV (a needle and tube going into the arm). This will help lower the chance of infection at the site of the cuts.
- The surgery will last between 3-6 hours. A surgery nurse will come out from time to time to let you know how your child is doing.
- In the recovery room, your child will be checked for complications and given pain medicine.
- There will be at least two catheters in place after the surgery: one in the new Mitrofanoff tube plus one in the urethra and/or one suprapubic catheter (through a cut in the belly). These will drain into a bag.The tubes will be temporary but you will go home with them for a few weeks.
- Your child may not be allowed to eat or drink for a period of time at the hospital. They will then start a clear liquid diet and eventually a regular diet.
Follow-Up Care After a Mitrofanoff Procedure
Your child’s catheters must stay in place for 3-4 weeks after the surgery. This allows the swelling to go down and the cuts and new tube to heal. You will have to return to the hospital for a nurse to remove the catheters. You and your child will also receive training from a nurse to learn how and when to catheterize using the new tube through the belly button. The nurse will provide some initial supplies and connect you with resources for home shipping for supplies in the future.
About 1 month after the surgical catheters come out, your child will need a follow-up ultrasound to check for swelling in the kidneys. This will let the doctor know if the surgery worked to effectively drain your child’s urine. Your child will also need an ultrasound at least every year to keep checking kidney health.
You should also expect the following after the Mitrofanoff procedure:
- The cut skin is usually closed with internal, absorbable stitches and skin glue (except for the new hole on the belly where the but connects, which stays open). The stitches disappear on their own and do not require any special removal or care.
- Your child can wash by sponge bath for the 2 days following the surgery. After that, showers are acceptable. Once the catheters are removed, baths are also okay.
- The cuts and catheters may be sore for a few days or weeks.
- Gym class, strenuous activity and heavy lifting should be avoided until the catheter is removed.
- Wheelchair transfers can begin again about 2 weeks after the operation.
- Your child must rinse (irrigate) the bladder once a day. This will be part of your child’s new routine. The rinse helps clear out mucus made by the appendix tube. If your child does not rinse the bladder, he or she may get kidney stones or infections.
You should call the doctor or seek medical attention for your child after the Mitrofanoff procedure if your child:
- Has a fever of 101°F or higher before the first follow-up visit
- Cannot pass urine through the catheter
- Passes blood through the catheter
- Accidentally pulls the catheter out
- Complains of severe pain in the belly, side or back that isn’t helped by the pain medicine they are given at discharge
- Has symptoms of a urinary tract infection (UTI) or kidney infection
- Feels pain or a blockage when catheterizing (once the surgery catheter is removed).
Benefits of the Mitrofanoff Procedure
Mitrofanoff procedures allow intermittent catheterization – once every few hours. This offers a lower risk of infection than a permanent (indwelling) catheter and allows one to not leak urine continually like an ileovesicostomies, which drain from a hole (stoma) in the belly into a bag.
After mitrofanoff, children do not have to wear diapers and can stay dry between catheterizations. They can often empty their bladders independently and without transfer to a toilet. The opening in the belly is very small; most are hard to see even when looking at the belly. All of these characteristics of the Mitrofanoff procedure may help it improve children’s quality of life.
Risks of the Mitrofanoff Procedure
In general, the risks of the Mitrofanoff procedure include those of any surgery, such as infection, redness, swelling, bleeding, reactions to the anesthesia or failure of the operation. During surgery on the bladder, urine can also leak into other areas and cause some irritation.
Mitrofanoff operations also carry several unique risks. Since the appendix is being partially detached and moved, there is a low risk of internal bleeding. It is possible that after a Mitrofanoff there may be problems catheterizing. Sometimes a different size catheter or more lubricant will solve the problem. The catheters put in place during surgery also make infections more likely than with other surgeries, but your child will receive a course of antibiotics during the recovery period to help avoid infections. The new hole in the belly may also leak. Finally, children who gain a lot of weight in the future may have problems catheterizing the opening.
The Mitrofanoff procedure has a high success rate. However, most children will eventually need another operation to adjust the appendix tube or fix problems, such as scarring that blocks the new opening to the belly. In many cases, these surgeries are minor and your child will not need an overnight stay at the hospital.
Questions to Ask Your Child’s Doctor About the Mitrofanoff Procedure
- Why do you recommend the Mitrofanoff procedure?
- What surgical techniques are available, and which do you recommend for my child?
- What are the alternatives to this surgery for managing my child’s incontinence?
- What are the pros and cons of this surgery versus the alternative options?
- Will my child need other operations at the same time?
- What will life be like with a catheter channel in the belly or at the belly button?
- How do you choose the location of the channel?
- What type of catheterization schedule will my child need to follow?
- What does my child need to do to be self-sufficient once the operation is done?
- Are there other patients or families who might be willing to speak about their experience with the Mitrofanoff procedure?
Mitrofanoff Procedures at Nationwide Children’s
At Nationwide Children’s, our goal is to get your child the help they need with the shortest possible recovery time. That is why we offer minimally invasive surgery for the Mitrofanoff procedure. Although we do perform open surgery when needed, robot-assisted Mitrofanoff procedures can help decrease pain, shorten hospital stays, speed recovery, and leave your child with less noticeable scars.
If the Mitrofanoff procedure is the right option for managing your child’s continence needs, talk to our surgeons about minimally invasive surgery. We will evaluate your child’s health needs to find out if your child is a good candidate for our robot-assisted surgical technique.
FAQs
Why is a Mitrofanoff procedure done? ›
Why Is the Mitrofanoff Procedure Done? The Mitrofanoff procedure is done for children who can not urinate on their own. Many of these children use traditional catheters before surgery. These catheters are inserted through the urethra, the normal place pee exits the body.
Is Mitrofanoff a major surgery? ›After the bladder is empty, the catheter is removed and the channel self-seals shut to prevent any leakage of urine between catheterizations. The Mitrofanoff procedure is considered major surgery. Recovery from this procedure usually takes six weeks.
How does a Mitrofanoff work? ›What is a Mitrofanoff? The Mitrofanoff procedure creates a channel into the bladder through which a catheter (thin, plastic tube) can be inserted to empty the bladder of urine, instead of passing urine through the urethra.
Is the Mitrofanoff procedure permanent? ›A Mitrofanoff (or continent catheterisable channel) is a tube created from the appendix or small intestine, which connects the bladder to the surface of the skin. It is tunnelled into the bladder in such a way that a 'valve' is created, which prevents urine leakage. The catheter is not left in place permanently.
How long does Mitrofanoff surgery take? ›The surgery will take 1 to 3 hours and is often done with other surgical procedures your child may need. After surgery, your child will go to the recovery room for a short time, and then back to his or her patient room.
How long does a Mitrofanoff last? ›complications of infections, stones and some stenosis, the Mitrofanoff channel can remain functional for at least 10 years.
Can you still pee with a Mitrofanoff? ›Can you still pee with a Mitrofanoff? Urine can still come out of the urethra after a Mitrofanoff. However, one of the goals of a Mitrofanoff is to prevent urinary leakage. If you empty your bladder regularly, you shouldn't experience leakage.
Can you swim with a Mitrofanoff? ›Once your wounds have fully healed you will be able to go swimming. It is advisable to wear a waterproof dressing over the Mitrofanoff while you are in the water.
How do you flush a Mitrofanoff? ›GUIDE TO FLUSHING A MITROFANOFF / SPC
Wash hands using soap and warm water. Empty leg bags before flushing. disconnect the Mitrofanoff catheter from the drainage bag. Kink the Mitrofanoff catheter to stop urine flow, Wrap the top of the leg bag in the same wipe to keep it clean.
For some, a Mitrofanoff has advantages over a suprapubic because there is no indwelling Foley tube or no collection bag. Also, the stoma is visible and accessible, making it easier than trying to insert a catheter into the urethra.
What causes neurogenic bladder? ›
Neurogenic bladder is the name given to a number of urinary conditions in people who lack bladder control due to a brain, spinal cord or nerve problem. This nerve damage can be the result of diseases such as multiple sclerosis (MS), Parkinson's disease or diabetes.
How long does a bladder augmentation last? ›Augmentation Cystoplasty (Bladder Augmentation) A cystoplasty (bladder augmentation) is a surgery that makes your bladder larger so you can hold more urine. The procedure takes anywhere from two to six hours.
Is a Mitrofanoff a urostomy? ›A Mitrofanoff is actually somewhat similar to a urostomy, except there's no need to use ostomy pouches. The Mitrofanoff procedure, also known as the Mitrofanoff appendicovesicostomy, was named after its inventor, Paul Mitrofanoff.
Is bladder augmentation surgery painful? ›You will probably feel some pain or cramping in your lower belly and may need pain medicine for a week or two. You will have a tube coming out of the cut the doctor made (incision) in your skin just above the pubic bone.
Do they put a catheter in during appendix surgery? ›During the procedure:
A breathing tube is usually put in your throat when you have general anesthesia. You may have a small tube (catheter) placed into your bladder through the urethra (the opening from the bladder to the outside of the body) to drain and measure urine from the bladder.
It will take 6 weeks from the date of surgery to fully recover from your operation. This can be divided into two parts -- the first 2 weeks and the last 4 weeks. During the first 2 weeks from the date of your surgery, it is important to be "a person of leisure".
What is a belly button catheter called? ›A suprapubic catheter (tube) drains urine from your bladder. It is inserted into your bladder through a small hole in your belly. You may need a catheter because you have urinary incontinence (leakage), urinary retention (not being able to urinate), surgery that made a catheter necessary, or another health problem.
Can you still pee normally with a suprapubic catheter? ›ANSWER: When a suprapubic catheter is needed long-term, returning to normal urination usually isn't feasible. In some cases, however, it may be possible.
Can you have surgery for incontinence? ›Vaginal mesh surgery is where a strip of synthetic mesh is inserted behind the tube that carries urine out of your body (urethra) to support it. Vaginal mesh surgery for stress incontinence is sometimes called tape surgery. The mesh stays in the body permanently. You'll be asleep during the operation.
What is Fowler's disease? ›What is Fowler's Syndrome? First described in 1985, it is a cause of urinary retention (inability to pass water normally) in young women. Urinary retention in young women is not common but can be quite debilitating. The abnormality lies in the urethral sphincter (the muscle that keeps you continent).
Who invented Mitrofanoff? ›
Professor Paul Mitrofanoff was a Paediatric Consultant Urologist and he created the Mitrofanoff procedure in 1976. The procedure was developed to help give individuals a better quality of life when suffering with incontinence and incomplete bladder emptying.
What is a kidney drain? ›A nephrostomy is a procedure to drain urine from your kidney using a catheter (tube). Urine normally drains from your kidneys into your bladder through small muscular tubes (ureters). Tests have shown that one or both of your ureters has become blocked.
What is a suprapubic catheter used for? ›A suprapubic catheter is used when the urethra is damaged or blocked, or when someone is unable to use an intermittent catheter. The catheter may be secured to the side of your body and attached to a collection bag strapped to your leg.
When would you do a bladder washout? ›Bladder washouts are used in patients who are catheterised and have haematuria. Significant haematuria will lead to blocking off of the catheter and clots forming in the bladder; this may precipitate further bleeding.
How do you flush a suprapubic catheter? ›Attach the syringe to the suprapubic tube. Pour 60 mL of saline into the top of the syringe. Raise the syringe and tube straight up to let the saline go through the tube. After the saline drains into your neobladder, remove the syringe and reconnect the suprapubic tube to the drainage bag.
How do you flush a catheter? ›How to flush a urinary catheter - YouTube
Do you have to wear a bag with a suprapubic catheter? ›Most suprapubic catheters come with a drainage bag that collects your urine until you can empty it out in the toilet or another container. Many people use a large bag at night and a smaller one during the day. You need to empty both types when they are about half-full or a little over.
What are the 3 types of urinary catheters? ›There are 3 main types of catheters: Indwelling catheter. Condom catheter. Intermittent self-catheter.
Can you live a normal life with self catheterization? ›The answer: Yes, you can continue to enjoy your life when using a urinary catheter. Whether your catheter is a temporary measure or a permanent fix, two things are likely: You're going to feel much better, but you may also feel self-conscious or embarrassed.
Can you pee with a neurogenic bladder? ›Neurogenic bladder is when a problem in your brain, spinal cord, or central nervous system makes you lose control of your bladder. You may pee too much or too little. You could have symptoms of both overactive bladder (OAB) and underactive bladder (UAB). You may not be able to fully empty it.
Does a neurogenic bladder ever get better? ›
While neurogenic bladder can't be cured, necessarily, it can most definitely be managed. Most cases of neurogenic bladder can be managed with medication and intermittent catheterization. The minority of children with the condition need major reconstructive surgery.
What medication treats neurogenic bladder? ›Drugs: Medications that treat neurogenic bladder include oxybutynin, tolterodine, mirabegron, solifenacin succinate and others. Injections of botulinum A toxin (Botox®): Your healthcare provider injects botulinum A toxin into your bladder or urinary sphincters.
What can you not do after bladder surgery? ›Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, for about 3 weeks, or until your doctor says it is okay. For about 3 weeks, avoid lifting anything that would make you strain.
Does your bladder grow if you drink more water? ›When you first start drinking more water, you may find that the frequent urination seems worse until your bladder starts to gradually enlarge. The best way to monitor your progress is to keep a bladder diary 1 or 2 days per week.
How often should you pee? ›For most people, the normal number of times to urinate per day is between 6 – 7 in a 24 hour period. Between 4 and 10 times a day can also be normal if that person is healthy and happy with the number of times they visit the toilet.
Which urinary diversion is best? ›The ileal conduit is the simplest type of urinary diversion and has the fewest surgical complications. In an ileal conduit, a surgeon creates a small opening in a patient's skin (a stoma) on the right lower abdomen, from which urine drains into a bag.
Can you still urinate with a urostomy? ›If your bladder has been removed or is damaged, this surgery will allow your body to remove urine so you can go back to your normal activities. With urostomy, you'll have to wear a pouch on the outside of your body. You won't be able to urinate normally like you would after continent urinary diversion surgery.
What is a permanent urine bag called? ›Urostomy pouches are special bags that are used to collect urine after bladder surgery. Instead of going to your bladder, urine will go outside of your abdomen. The part that sticks outside your abdomen is called the stoma.
What is the maximum amount of urine the bladder can hold? ›Urinary bladder and urethra
The urinary bladder can store up to 500 ml of urine in women and 700 ml in men. People already feel the need to urinate (pee) when their bladder has between 200 and 350 ml of urine in it.
How to Empty Your Bladder and Overcome Incomplete ... - YouTube
How can I relax my bladder to pee? ›
To perform, squeeze your pelvic floor muscles — as if you're trying to stop your stream of urine — for three seconds. Relax for a count of three and repeat several times. Your doctor might recommend that you do a set of these exercises three or four times a day, lying down, sitting and standing.
Why would you need a Mitrofanoff? ›The Mitrofanoff procedure creates a channel that allows urine to be emptied through a channel in the abdomen, rather than through the urethra. The procedure is an option for patients with spinal cord injuries or that have difficulty with self-catheterization.
Why is a Mitrofanoff procedure done? ›Why Is the Mitrofanoff Procedure Done? The Mitrofanoff procedure is done for children who can not urinate on their own. Many of these children use traditional catheters before surgery. These catheters are inserted through the urethra, the normal place pee exits the body.
How many stitches are in an appendix surgery? ›Finally, they gently disconnect your appendix and take it out through one of the incisions. Most operations need 3 incisions, but this can vary from 1 (one) to 4, based on various circumstances.
Can you still urinate with a Mitrofanoff? ›Can you still pee with a Mitrofanoff? Urine can still come out of the urethra after a Mitrofanoff. However, one of the goals of a Mitrofanoff is to prevent urinary leakage. If you empty your bladder regularly, you shouldn't experience leakage.
What is the difference between Mitrofanoff and suprapubic catheter? ›For some, a Mitrofanoff has advantages over a suprapubic because there is no indwelling Foley tube or no collection bag. Also, the stoma is visible and accessible, making it easier than trying to insert a catheter into the urethra.
What causes neurogenic bladder? ›Neurogenic bladder is the name given to a number of urinary conditions in people who lack bladder control due to a brain, spinal cord or nerve problem. This nerve damage can be the result of diseases such as multiple sclerosis (MS), Parkinson's disease or diabetes.
Is a Mitrofanoff a urostomy? ›A Mitrofanoff is actually somewhat similar to a urostomy, except there's no need to use ostomy pouches. The Mitrofanoff procedure, also known as the Mitrofanoff appendicovesicostomy, was named after its inventor, Paul Mitrofanoff.
Can you swim with a Mitrofanoff? ›Once your wounds have fully healed you will be able to go swimming. It is advisable to wear a waterproof dressing over the Mitrofanoff while you are in the water.
How do you flush a Mitrofanoff? ›GUIDE TO FLUSHING A MITROFANOFF / SPC
Wash hands using soap and warm water. Empty leg bags before flushing. disconnect the Mitrofanoff catheter from the drainage bag. Kink the Mitrofanoff catheter to stop urine flow, Wrap the top of the leg bag in the same wipe to keep it clean.
What is a belly button catheter called? ›
A suprapubic catheter (tube) drains urine from your bladder. It is inserted into your bladder through a small hole in your belly. You may need a catheter because you have urinary incontinence (leakage), urinary retention (not being able to urinate), surgery that made a catheter necessary, or another health problem.
Can you pee out of your belly button? ›A patent urachus can cause varying amounts of clear urine to leak at the umbilicus. This occurs when the urachus did not seal close to the umbilicus and leads to a blind ending tract from the umbilicus into the urachus called a sinus.
Do you have to wear a bag with a suprapubic catheter? ›Most suprapubic catheters come with a drainage bag that collects your urine until you can empty it out in the toilet or another container. Many people use a large bag at night and a smaller one during the day. You need to empty both types when they are about half-full or a little over.
Can you pee with a suprapubic catheter? ›By clamping and unclamping the catheter, you will learn to urinate the way you did before you received the catheter. The amount of urine that you pass through the urethra will increase, and the amount of urine draining from your catheter will decrease.
Can you pee with a neurogenic bladder? ›Neurogenic bladder is when a problem in your brain, spinal cord, or central nervous system makes you lose control of your bladder. You may pee too much or too little. You could have symptoms of both overactive bladder (OAB) and underactive bladder (UAB). You may not be able to fully empty it.
Does a neurogenic bladder ever get better? ›While neurogenic bladder can't be cured, necessarily, it can most definitely be managed. Most cases of neurogenic bladder can be managed with medication and intermittent catheterization. The minority of children with the condition need major reconstructive surgery.
What medication treats neurogenic bladder? ›Drugs: Medications that treat neurogenic bladder include oxybutynin, tolterodine, mirabegron, solifenacin succinate and others. Injections of botulinum A toxin (Botox®): Your healthcare provider injects botulinum A toxin into your bladder or urinary sphincters.
Which urinary diversion is best? ›The ileal conduit is the simplest type of urinary diversion and has the fewest surgical complications. In an ileal conduit, a surgeon creates a small opening in a patient's skin (a stoma) on the right lower abdomen, from which urine drains into a bag.
What is a permanent urine bag called? ›Urostomy pouches are special bags that are used to collect urine after bladder surgery. Instead of going to your bladder, urine will go outside of your abdomen. The part that sticks outside your abdomen is called the stoma.
Do you still urinate with an ileostomy? ›You empty the urine by opening a valve on the pouch and drain the urine into a toilet. At night, you can attach a piece of flexible tubing to the drain valve on your pouch to allow urine to flow into a night drainage unit while you sleep.