The Mitrofanoff (mi-troe-fan-off) Procedure is a surgical procedure in which a tube created inside the body connecting the bladder to the surface of the abdomen. This tube is constructed using tissue from the bowel (most common), appendix, fallopian tube, or ureter segment so that catherization of the bladder can be done through the abdomen to the bladder. The opening of the passageway, or stoma, on the abdomen is often placed in the folds of the belly button or nearby.
The Mitrofanoff allows you easy access to the bladder via the stoma to perform intermittant catherization to drain the bladder with minimal undressing; and, without having to move from a wheelchair. This is usually an easier and more comfortable catherization than through the urethra.
The Mirofanoff is a surgery that may take 2-3 hours. It is sometimes done at the same time as other bladder/bowel surgeries like a Bladder Augmentation or ACE procedure. Your preop instructions will include a clear liquid diet and a "bowel prep" or cleansing; and, possibly oral antibiotics. Sometimes, depending on the age or needs of the patient, you may need to be admitted to the hospital the day before surgery. Please discuss your specific bowel prep instructions with your surgeon.
After surgery, you will have an intraneous line (IV), two catheters (one in the Mitrofanoff and one in the bladder either urethral or a suprapubic). The catheter in the Mitrofanoff keeps the stoma open while healing and the bladder catheter allows the bladder to drain. There also may be a nasogastric (NG) tube leading from the nose into the stomach, to keep the stomach empty. The NG tube may stay in for several days until the bowel heals enough to start working again. As the tube comes out your diet will progress from drinking clear liquids to eating solid foods as tolerated. You will be provided pain mediation as needed. You may anticipate a hospitalization from 3-10 days depending on what other procedures have been done and how you are recovering.
When at home, you will need maintain the catheter(s). Make sure that the catheters are secured so that they are not accidently pulled out while bathing, dressing or in transfers. Daily cleansing around the catheters with water is recommended. Pat dry and apply dressing (4x4 and tape) if needed. Empty the drainage bag as needed throughout the day. If bladder irrigations are needed, you will be instructed in this technique before going home. You will need to clean the abdominal incision at least once a day. Apply a dressing if needed. Once home, follow a normal diet. Any activity that stresses the abdomen should be limited until 6 weeks after surgery. The catheter(s) will be taken out in the office 2-3 weeks after surgery. Often, the bladder catheter is plugged for 24-48 hours while you are starting to learn to catherize the stoma. The bladder catheter is then removed. If you have a suprapubic catheter (a catheter placed directly through the abdomen into the bladder) you will need to keep this opening covered with a dressing for several days as the tube heals closed. Please make sure this appointment is scheduled. You will be taught how to catherize the stoma at this visit. We will discuss the size and type of catheter best for the stoma catherization at this visit. We can help you order supplies at this time if needed.
When to call the surgeon:
if the catheter(s) fall out
temperature of 101.5 F or higher
bleeding at the stoma (not just spotting)
no urine draining from the catheter
Long term Care Issues:
catherization technique and schedule important to reduce/prevent infections and to protect the kidneys
bladder spasms that may require medications to control
difficulty with drainage - irrigation program and technique needs to be assessed
recurrent UTI's (urinary tract infections) - always notifiy the surgeon if you suspect an infection
difficutly placing catheter in the stoma - if unable to pass the catheter, call the surgeon right away
yearly, routine followup care may include lab work and ultrasound to evaluate the kidneys and bladder
countine yearly health physical with primary care provider