Mitrofanoff procedure (catheterisable urinary stoma)

Q 1. What does the procedure involve?

A. This is a procedure to create a channel (for catheterisation) between the skin and either the bladder or a urinary reservoir. This is likely to be done in conjunction with another procedure (either enlarging the bladder with a bowel patch or creating a urinary reservoir).

Q 2. What are the alternatives to this procedure?

A.

• Use of a catheter via the urethra (water pipe)
• Urinary stoma with a bag.

Q 3. What should I expect before the procedure?

A. You will usually be admitted on the same day as your surgery. You will normally undergo pre assessment on the day of your clinic or an appointment for pre assessment will be made from clinic, to assess your general fitness and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and nurse.

You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

• Co-morbidities like Diabetes, Hypertension, Coronary artery disease or, stroke, epilepsy
• Any transmissible disease like HIV/AIDS, Hepatitis B or C etc
• Presence of implants, pacemakers, graft etc
• You are taking prescription drugs like-
  • Blood thinners/ anti-platelets i.e. Warfarin, ecosprin, clopidogrel etc
  • Anti-epileptics like phenytoin, valproate etc

Q 4. What happens during the procedure?

A. A full general anaesthetic (where you will be asleep throughout the procedure) will be used. Appendix is isolated on its own blood supply.

The channel will be created using the appendix, a short segment of small intestine (ileum) or a combination of both. It will be joined to the skin by a flap fashioned into a small pit, rather like a second umbilicus (navel).

Q 5. What happens immediately after the procedure?

A. You may experience discomfort for a few days after the procedure but painkillers will be given to you to take home.

Following completion of the procedure a catheter will be inserted into the channel (for about three weeks), together with one or two catheters into the bladder or urinary reservoir (also for up to three weeks), to promote drainage and to allow the suturing to heal up completely.

You will probably be able to go home, once you are mobile, with the catheters in place, having been taught how to manage them.

You will be re-admitted three weeks after the operation for removal of these catheters and to be taught how to pass a catheter into the Mitrofanoff stoma.

Q 6. What is the duration of stay?

A. The average duration of stay is 5 to 7 days.

Q 7. What are the side effects/complications?

A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Common (greater than one in 10)

• The channel may become narrowed, requiring either a catheter to be left for about two weeks or, possible, further surgery to correct the problem
• The channel may not hold urine without leakage, leading to further surgery to correct the problem

Occasional (between one in 10 and one in 50)

• The catheter placed after surgery may fall out, possibly requiring a further operation to replace it or to re-fashion the channel
• The skin or bowel from which the channel is formed may die, requiring further surgery to re-fashion it

Rare (less than one in 50)

• Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death)
• Scarring of the bowel requiring further surgery

Q 8. What should I expect when I get home?

A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.

It will be at least six weeks before full healing occurs and you may return to work/ moderate activity when you are comfortable enough and your urologist is satisfied with your progress.

Q 9. What else should I look out for?

A. If you develop fever or vomiting (especially if associated with unexpected pain in your abdomen), temperature, increased redness, throbbing or drainage at the site of the operation, please contact your urologist.

If there is any difficulty passing a catheter into the Mitrofanoff channel, please contact your urologist.

Q 10. What are other important points?

A. A follow up outpatient appointment will normally be arranged six to eight weeks after the operation to assess the outcome.