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.
This channel – which looks like an extra tummy button – is usually referred to as a ‘Mitrofanoff’, and is created in an operation under general anaesthetic. Sometimes, this is done during an operation to enlarge your child’s bladder (bladder augmentation).
Children who are incontinent (wet) may benefit from this procedure. It allows the bladder to be emptied several times a day, reducing the chance of the bladder leaking urine. It can be psychologically easier and physically less uncomfortable to insert a catheter into the Mitrofanoff rather than the urethra.
It can also allow older children to lead a more normal life. The Mitrofanoff procedure is often used for children with bladder problems due to spina bifida, bladder exstrophy or bladder obstruction (posterior urethral valves).
What happens before the operation?
Before your child comes in for the operation, you may want to come to the hospital for a pre-admission clinic. More details about this are in your admission letter.
You will already have received information about how to prepare your child for the operation in the 'Welcome to GOSH: a guide for families' booklet and your admission letter.
The surgeon will visit you to explain about the operation in more detail, discuss any worries and ask you to sign a consent form giving your permission for the operation. Another doctor will also visit you to explain about the anaesthetic and options for pain relief after the operation.
If your child has any medical problems, particularly allergies and constipation, please tell the doctors about these. Please also bring in any medicines your child is currently taking.
Your child may need to have his or her bowel prepared for surgery. This means it will need to be empty of poo. Your child may need to take some medicine (or have an enema if he or she has an existing bowel problem) some time before the operation. During this bowel emptying process, your child will not be able to eat any solid food and only drink clear fluids.
What does the operation involve?
If your child has already had his or her appendix removed or if it is not suitable, the surgeon may need to use a piece of the small intestine to create the channel.
The surgeon will disconnect your child’s appendix from its usual position on the large intestine and open it up to form a tube. He or she will then connect one end to a small incision (cut) in your child’s bladder and the other end to another small incision in your child’s abdomen.
The surgeon will also create a ‘valve’ where the tube joins the bladder, which squeezes shut as the bladder fills with urine. This will reduce the chance of urine leaking from the Mitrofanoff.
Your child will be away from the ward for about three hours, although it may take longer if he or she is having another procedure at the same time, such as bladder augmentation. The usual hospital stay is about seven days.
Are there any risks?
All treatments carry an element of risk, but this must be balanced against the quality of life without treatment.
All surgery carries a risk of bleeding during or after the operation. Every anaesthetic carries a risk of complications, but this is very small. Your child’s anaesthetist is a very experienced doctor who is trained to deal with any complications.
After an anaesthetic, your child may feel sick and vomit. He or she may have a headache, sore throat or feel dizzy. These side effects are usually short-lived and not severe.
There is a chance the Mitrofanoff could be difficult to catheterise, as the opening is too narrow or the valve too tight. This affects about a quarter of all children with a Mitrofanoff but it is easy to correct.
Are there any alternatives?
Your child could catheterise using the urethra, which some children find quite difficult. Another alternative is to do nothing, and allow your child to remain wet.
What happens afterwards?
Your child will come back to the ward to recover. For the first day or two, he or she will have a drip giving fluids and medication, until the bowel starts to recover. The drip will be removed when your child starts eating and drinking again.
The surgeon will have inserted a catheter into the Mitrofanoff to keep it open. This should stay in place for three to four weeks after the operation.
Your child may also have a suprapubic catheter for a while after the operation, to allow the bladder and Mitrofanoff to heal. During this time, the catheter will be connected to a collection bag, so urine can drain freely from the bladder. You can find more infomration on the looking after your child’s suprapubic catheter page.
It is quite common for children to have bladder spasms after this type of operation, and also to leak a small amount of urine, which may be tinged with blood. This is quite normal, and we will give you medication to deal with the bladder spasms before you go home. A few days after the operation, paracetamol or ibuprofen will be enough to deal with any remaining discomfort.
Last reviewed by Great Ormond Street Hospital: Novemeber 2009
Ref: 2009F0654 © GOSH Trust November 2009
Compiled by the Urology Department and Louise Ward in collaboration with the Child and Family Information Group.
This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.