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Mitrofanoff Procedure

What Is the Mitrofanoff Procedure?

Mitrofanoff, also known as appendicovesicostomy, is a surgical procedure used for children to empty their bladders by catheterizing through the belly button instead of the urethra. Surgeons use the child's appendix to create a catheter channel between the skin and the bladder. The channel goes from the bladder to the abdominal wall, usually through the belly button.

Who Is a Candidate for the Procedure?

The Mitrofanoff procedure is done for children who cannot urinate on their own. Many of these children have been using traditional catheters that are inserted through the urethra, which is the normal place where urine exits the body. However, catheters through the urethra can cause pain in boys, and may be difficult for girls to insert because of their anatomy.

This procedure greatly benefits children who have difficulty catheterizing through the urethra, because without the surgery they might have to continue to wear diapers. Sometimes, the sphincter muscles do not work well and the child continues to leak into a diaper. Diapers can become socially uncomfortable for children as they age.

Patients suffering from these conditions may benefit from the Mitrofanoff procedure:

  • Spina bifida and myelomeningocele
  • Neurogenic bladder
  • Any child needing long-term urinary catheterization

What to Expect From Surgery

During the procedure, your child will have two catheters inserted. The surgery will take a couple of hours, and your child will have a hospital stay.

Preparing for surgery

Because the surgeon will remove your child's appendix, it is important to make sure that your child's bowel is as clean as possible before the operation. Cleaning the bowel requires you to restrict what your child eats, and also use enemas.

For 2 to 3 days before the operation, your child should only have clear fluids to drink. Clear fluids are liquids you can see through, like water, apple juice, ginger ale, Sprite and Jello. Your child cannot have anything else to eat or drink.

After surgery

The catheters will remain in place for 3 to 4 weeks after surgery. One of the catheters will be in the urethra as an indwelling catheter (one that stays inserted for an extended period of time) to drain urine, and the other catheter will be in the Mitrofanoff site. This catheter will allow the swelling and remaining fluid to be removed until the site heals. During the follow-up office visit, the catheter will be removed and you will be taught how to catheterize using the new channel, via the belly button.

You should call the doctor if your child experiences any of the following:

  • Fever of 101°F or higher
  • Cannot pass urine through the catheter
  • Accidentally pulls out the catheter
  • Complains of severe pain in the belly, side or back that isn't helped by the pain medicine
  • Has symptoms of a urinary tract infection or kidney infection
  • Feels pain or a blockage when catheterizing (once the surgery catheter is removed)