The Mitrofanoff

Mitrofanoff treatment is a type of surgical procedure required for patients who have a problem emptying their bladder. The aim of the treatment is to create a catheterisable channel between your bladder and the surface of the skin which allows the bladder to be emptied.

What is a Mitrofanoff?

A Mitrofanoff (or continent catheterisable channel) is a tube created from the appendix or small intestine. As mentioned before, this channel 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. Instead, it is passed into the bladder every three to four hours or when the bladder is full. Once the urine and mucus have been drained, the catheter is removed. Regular bladder emptying will ensure that all urine and mucus are removed, which prevents urine infections and/or bladder stones developing.

The Surgical Procedure

This procedure is carried out under general anaesthetic which means you will be asleep during the operation and will not feel any pain.

An incision is made in the lower part of your abdomen. A channel is created (called a Mitrofanoff channel) from your appendix, a short segment of the small intestine or a combination of both. One end is tunnelled into the bladder and the other end is connected to the wall of the abdomen (tummy). This makes a small opening on the surface of the skin called a Mitrofanoff stoma.

The Mitrofanoff stoma can be placed low down below the level of most underwear or sometimes it can be put where the tummy button is. The abdominal incision is then closed with stitches or clips. Absorbable stitches are used to anchor the channel to your skin, they normally disappear after two to three weeks.

Before Surgery

When it is established that you require this treatment you will have a pre-assessment before the surgery. This is to assess your general fitness, to do any required blood tests and measure your blood pressure. The risks and benefits of this procedure will be explained and you will have the opportunity to ask any questions you may have.

You may be admitted to hospital a day before or on the day of surgery. Sometimes it is necessary to empty the bowel and make sure it is clean before the operation takes place. This is done by changing what you eat and giving you medicine to empty the bowel.

After Surgery

Immediately after surgery you will be taken to a recovery room and monitored until you are stable. Three catheters will have been inserted into your bladder, in your Mitrofanoff, urethra and tummy. This drains your urine while your bladder heals. Pain relief medication can be prescribed if you are in any pain.

You will be encouraged to mobilise as soon as possible after the operation to encourage your bowel to start working again. A physiotherapist will be available to show you some deep breathing and leg exercises.

Most patients will need to stay in hospital for 3 to 5 days before being discharged. It will take a minimum of 6 weeks to recover from this surgery. You must heavy lifting for 3 months as this will strain the abdominal muscles.

Risks and benefits

The major benefit of this procedure is that it provides a route to empty your bladder without the aid of a urinary catheter, this route is more convenient for some patients. It also provides a long-term solution that enables you to maintain a normal quality of life, and it reduces the risk of urine infections or bladder stones developing.

All surgical procedures carry an element of risk. Your consultant will discuss these risks with you prior to the treatment, they include;

  • Urine infection

  • Wound infection

  • The catheter placed during surgery may fall out requiring a further operation to replace it

  • The channel may become narrowed (stenosis) needing a catheter to be left in for a period of time (for one week or several weeks this varies from patient to patient) or further surgery to correct the problem

  • The channel may leak urine requiring further surgery to correct the problem

  • The tissue (connective structure) used to form the channel may die requiring further surgery to amend it

  • Stones can form within the bladder when it is not fully drained and there is incomplete emptying.

Rare complications include anaesthetic or cardiovascular problems such as chest infection, pulmonary embolus (blood clots in the lungs), stroke, deep vein thrombosis (blood clots in the veins), heart attack and death. Plus, scarring of the bowel which may require further surgery.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

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