The Mitrofanoff procedure creates a channel into your bladder through which a catheter (thin, plastic tube) can be inserted to empty your bladder of urine, instead of passing urine through the urethra.
You might need this procedure at Great Ormond Street Hospital (GOSH) if you have problems with your bladder.
How it works
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 bladder (bladder augmentation).
People 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 you to lead a more normal life. The Mitrofanoff procedure is often used for people with bladder problems due to spina bifida, bladder exstrophy or bladder obstruction (posterior urethral valves).
Before you come 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 for the operation from GOSH and in your admission letter.
The surgeon will visit you to explain about the operation in more detail, discuss any worries and ask you or your parents to sign a consent form giving permission for the operation. Another doctor will also visit you to explain about the anaesthetic and options for pain relief after the operation.
If you have any medical problems, particularly allergies and constipation, please tell the doctors about these. Please also bring in any medicines you are currently taking.
You may need to have your bowel prepared for surgery to make sure it’s empty of poo. You may need to take some medicine (or have an enema if you have an existing bowel problem) some time before the operation. Once your bowel is empty, you won’t be allowed to eat any solid foods until after you’ve had the procedure and you’ll only be able to drink clear fluids.
The surgeon will disconnect your appendix from its usual position on the large intestine and open it up to form a tube. The tube is used as the channel for your urine to pass through. You will then connect one end to a small incision (cut) in your bladder and the other end to another small incision in your abdomen.
If you’ve already had your appendix removed or if it’s not suitable, the surgeon may need to use a piece of your small intestine to create the channel.
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.
The procedure takes about three hours, although it may take longer if you’re having another procedure at the same time, such as bladder augmentation. The usual hospital stay is about seven days.
You will come back to the ward to recover. For the first day or two, you will have a drip giving fluids and medicine, until your bowel starts to recover. The drip will be removed when you start eating and drinking again.
Your 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.
You 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.
It’s quite common to have bladder spasms after this type of operation. You might also leak a small amount of urine, which may be tinged with blood. This is quite normal, and we will give you medicine 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.
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 anaesthetist is a very experienced doctor who is trained to deal with any complications.
After an anaesthetic, you may feel sick and vomit. You may have a headache, sore throat or feel dizzy. These side effects are usually short-lived and not severe.
There’s a chance the Mitrofanoff could be difficult to catheterise, as the opening is too narrow or the valve too tight. This happens in about a quarter of all cases, but it’s easy to correct.
You could catheterise using your urethra, but some people find this quite difficult. Another alternative is to do nothing, but the problem of incontinence will remain.