Mitrofanoff procedure

Overview

The Mitrofanoff procedure is a surgical technique used to create a continent urinary diversion. It is primarily used in patients who require an alternative method for bladder emptying due to neurogenic bladder, bladder exstrophy, or other conditions that impair normal urinary function. The procedure involves the creation of a conduit, typically using the appendix, to connect the bladder to the abdominal wall, allowing catheterization through a stoma.

Diagram of the Mitrofanoff procedure

History

The procedure was first described by Paul Mitrofanoff in 1980. It was developed as a means to provide patients with a reliable and continent method of bladder management, particularly for those with spina bifida or other congenital abnormalities affecting the urinary tract.

Indications

The Mitrofanoff procedure is indicated for patients who:

• Have difficulty with urinary incontinence
• Require frequent catheterization
• Have undergone previous bladder surgeries that affect normal voiding
• Have conditions such as spinal cord injury or multiple sclerosis that impair bladder function

Surgical Technique

The procedure typically involves the following steps:

Creation of the Conduit

The appendix is most commonly used to create the conduit, although other tissues such as a segment of the ileum can be used if the appendix is unavailable. The chosen tissue is isolated and prepared to form a channel between the bladder and the skin surface.

Formation of the Stoma

A small opening, or stoma, is created on the abdominal wall. This stoma serves as the entry point for catheterization. The conduit is tunneled subcutaneously to this stoma, ensuring that it remains continent when not in use.

Bladder Augmentation

In some cases, bladder augmentation may be performed concurrently to increase bladder capacity and reduce pressure. This is often done using a segment of the intestine.

Postoperative Care

After the procedure, patients require education on self-catheterization through the stoma. Regular follow-up is necessary to monitor for complications such as urinary tract infection, stoma stenosis, or conduit leakage.

Complications

Potential complications of the Mitrofanoff procedure include:

• Stomal stenosis
• Urinary tract infections
• Leakage from the conduit
• Formation of bladder stones

Related pages

• Urinary diversion
• Bladder augmentation
• Neurogenic bladder
• Spina bifida