What is a MITROFANOFF
Summary
This provides information on the Mitrofanoff procedure, 
If we have missed something, please let us know and we will do our upmost to provide you with the information you need.

Mitrofanoff Procedure
Professor Paul Mitrofanoff created the Mitrofanoff (mi-trof-fan-off) procedure in 1976, also known as the Mitrofanoff Appendiciovesicostomy
or a Continent Urinary Diversion. The Mitrofanoff was introduced to permit bladder drainage where voiding or urethral self-catheterisation
is not possible. For a patient the procedure enables them to maintain dignity and means that there is no need to have an indwelling
catheter or wear a stoma bag. 

What is a MITROFANOFF
•  Creates a channel into the bladder
•  A catheter is used via the channel to empty the bladder

The purpose of this operation is to form a channel between the bladder and the wall of the abdomen to allow intermittent
self-catheterisation ie, drainage of the bladder. The Mitrofanoff is preferentially made from the appendix (or small bowel) which is
mobilised on its blood supply or a piece of bowel, this can also be achieved with a fallopian tube. One end is tunnelled into the wall
of the bladder to create a valve that acts as a continent mechanism, the other end is passed through an opening in the abdominal wall
to form a small stoma through which a catheter can pass to empty the bladder 4-6 times a day. 
The Mitrofanoff is often situated on the right-hand side of the lower abdomen, just below the underwear line or for cosmetic
appearances another possible site is the umbilicus.

Considering a Mitrofanoff? 
The procedure may be an option due to the following conditions:

• Congenital birth malformations ie; bladder exstrophy, bladder epispadias, spina bifida and neurogenic bladder
• Multiple Sclerosis
• Spinal Cord Injuries and paraplegia
• Bladder cancer patients and in some cases prostate or bowel cancer
• Incontinence of urine via the urethra
• Unable to pass urine via the urethra

 Bladder enlargement or replacing a bladder:
• Bladder augmentation, this is to enlarge a small bladder and to create a sufficient reservoir
• Neo bladder, when a new bladder is created due to disease

When creating an augmented or a neo bladder low pressure must be ensured to and protect the kidneys from back pressure. 

Complications, post operatively
• Stenosis (narrowing)
• Leaking
• Stones 
• Infections

Stenosis is when narrowing of the channel occurs. If the channel becomes narrow the first step would be to leave a catheter
in situ for one week. If narrowing continues you may be required to undergo a revision and in some cases more significant surgery. 
Leaking can occur via the stoma which can be due to a non-functioning valve, a small bladder or high-pressure bladder.
This can be assessed by a non-invasive test called urodynamics. 

Stones can be produced within the bladder when the bladder is not fully drained and there is incomplete emptying.
Due to the type of tissue used for a Mitrofanoff, bladder augmentation or neo bladder there will be a build-up of mucus within the urine,
which can also create stones. Regular bladder washouts can reduce and help this.

Infections can develop when there is low fluid input to flush the kidneys and bladder, this is why drinking is vital.
Urinary tract infections can also occur when the bladder is not fully drained and incomplete emptying of all the bugs the bladder produces.
Poor personal, hand and catheter hygiene can also result in infections. All procedures and surgery come with risks and complications,
the Mitrofanoff procedure may not be suitable or successful in some cases.

Benefits
The Mitrofanoff procedure can be a long-term solution to enable patients to maintain a normal life and dignity.

Bladder Washout’s
The purpose of a bladder washout is to remove debris and mucous from your bladder.  Bladder washouts usually need to be
performed when a bladder augmentation or neo-bladder has been created. When bowel is used to create the bladder mucous and
debris will be produced. An accumulation of mucous in the bladder can lead to an increased amount of infections and kidney stones.   

Equipment 
Bladder syringe 
Clean Jug
Saline/cool boiled water (1 litre = a level teaspoon of salt)
Catheter 
Procedure

Firstly, insert the catheter as normal and drain off any urine present in the bladder.
The 50ml bladder syringe is filled with the saline and is connected to the catheter.  The saline is then inserted into the bladder.
Leave a few millilitres in the syringe.  Withdraw the water from the bladder. If the syringe contains a large amount of mucous repeat
the process. You may find that moving your hips from side to side helps to dislodge the mucous and make it easier to remove. 

A healthcare professional will advise you initially on how regularly to perform bladder washouts.This is usually once a week unless you
have the catheter in situ all the time.You will soon develop your own pattern for doing this dependent on how much mucous you produce.
There are certain foods and conditions where you may produce more mucous.  This includes dairy products, fizzy drinks,
real ale or if you have a head cold, hay fever or a gastrointestinal upset. 

Your usual Home Delivery Service can supply the 50ml bladder syringes, usually free of charge. 

B12 Deficiency
You may need a regular B12 injection as this procedure can lead to B12 defeciency.
As always with seek medical Advice from your specialist nurse or GP.