Between 1976 and 1980 a procedure was created called the Mitrofanoff, 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 person who created this procedure is called Professor Paul Mitrofanoff
What is a Mitrofanoff?
The purpose of this operation is to form a channel between the bladder and
the wall of the abdomen to allow intermittent self-catheterisation i.e. drainage
of the bladder. Ideally the Mitrofanoff is created from the appendix (or
small bowel) which is mobilised on its blood supply. A section of the large bowel
or fallopian tube can also be used. 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, or in the umbilicus.
- Creates a channel into the bladder
- A catheter is used via the channel to empty the bladder
The reasons behind a mitrofanoff could be for the various conditions:
- Congenital birth malformations i.e. bladder exstrophy, bladder epispadias, spina bifida and neurogenic bladder
- Multiple Sclerosis
- Spinal cord injuries and paraplegia
- Bladder cancer patients and in some cases prostate or bowel cancer
Bladder enlargement or replacing a bladder:
- Bladder augmentation using bowel – this is to enlarge a small bladder and to create a sufficient reservoir
- Neobladder – the bladder is replaced by a new bladder (neobladder) constructed from the bowel. This is usually required when the individual has conditions such as cancer and the entire bladder needs to be removed.
When creating an augmented or a neo bladder low pressure must be ensured to protect the kidneys from back pressure.
If you have had bowel used to augment your bladder you will have to do regular bladder washouts to remove mucus. You will also require regular blood checks for Vitamin B12, chloride and bicarbonate.
If you have your native bladder you may not need the following regularly:
- Bladder washouts – you will not produce as much mucus but this may be required just after the operation.
- Vitamin B12 – is absorbed in the terminal ileum and therefore if no bowel has been used vitamin B12 should be absorbed as normal.
- Bicarbonate or chloride – if a native bladder is used for the reservoir and no additional bowel is required there should be no imbalance or absorption of bicarbonate or chloride.
Some of the complications that may occur:
- Stenosis (narrowing)
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 contact your nurse specialist or surgeon as you may require further surgery.
Leaking can occur via the stoma. A moderately invasive test called urodynamics may be necessary to assess the cause e.g. a non-functioning valve, a small bladder or high pressure bladder.
Stones can be produced within the bladder when it is not fully drained and there is incomplete emptying. Due to the type of tissue used for a Mitrofanoff with bladder augmentation or neobladder, 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 plenty of water 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.
The benefits for one
The Mitrofanoff works well for many people. However, all procedures and surgery come with risks and complications and the Mitrofanoff procedure may not be suitable or successful for some.