Mitrofanoff Procedure

The Mitrofanoff procedure, also known as an appendicovesicostomy, is a surgical option for children who have trouble emptying their bladder due to certain medical conditions. The procedure creates a channel from the bladder to a small opening on the abdomen, in or near the belly button.

After a Mitrofanoff procedure, a child empties their bladder of urine through a catheter placed in the channel. Emptying the bladder through a Mitrofanoff channel, rather than the urethra (the tube that normally allows urine to leave the body), can be easier and more comfortable.

The Mitrofanoff procedure helps many children gain independence in toileting and enables children in wheelchairs to empty their bladder without transferring to a toilet. It can also help children to stay dry between catheterizations.

The Mitrofanoff procedure may help children who have trouble peeing on their own and draining their bladder. This procedure is an option for children with bladder issues related to:

• Spina bifida
• Bladder exstrophy
• Cloacal exstrophy
• Epispadias
• Neurogenic bladder
• Cerebral palsy
• Spinal cord injury

The procedure typically takes about three hours. Sometimes a child’s bladder may be operated on at the same time to enlarge it. If your child is having other procedures in addition to the Mitrofanoff procedure, they will be in the operating room longer.

During the procedure

• Your child will be given general anesthesia so that they fall into a deep sleep and won’t feel pain during the procedure.
• Your child’s surgeon will disconnect the appendix (a narrow, finger-like pouch) from the large intestine so that it can be used to form a channel.
• If your child’s appendix has been removed for another reason, the surgeon will use a segment of small intestine to create a channel.
• The surgeon will attach one end of the channel to your child’s bladder and create a valve that closes when the bladder fills with urine. This will help to prevent urine from leaking through the Mitrofanoff channel.
• The surgeon will then attach the other end of the channel to a small opening on your child’s abdomen, in or near the belly button. This opening is called a stoma.

Whenever possible, the urologic surgeons at Boston Children’s Hospital use minimally invasive surgical methods, including robotic technology, to perform the Mitrofanoff procedure. Narrow robotic arms make it possible to create the Mitrofanoff channel through very small incisions.

At the hospital

• Your child will stay in the hospital for five to seven days after the procedure.
• There will be a temporary catheter in the new channel that will remain in place for three to four weeks. Its purpose is to keep the channel open while your child heals.
• Your child may also have a temporary catheter, known as a suprapubic catheter, through their lower abdomen. This catheter will be connected to a collection bag outside of the body so that urine can freely drain from the bladder during the healing process.

Follow-up care

• Three to four weeks after surgery, a nurse will remove the catheter from the new channel and show you how to empty your child’s bladder through the channel.
• If your child has a suprapubic catheter, the nurse will probably remove it during the same visit.
• Your child should avoid gym class, strenuous activities, and sports until the catheters are removed.
• Approximately one month after the catheters are removed, and then once every year, your child will need an ultrasound of their kidneys and bladder. This will allow the care team to assess your child’s urine drainage and kidney health.

After the channel has healed, your child will follow these steps to empty their bladder once every few hours:

• Gently insert a catheter into the stoma, through the Mitrofanoff channel, and into the bladder.
• Leave the catheter in place to drain all urine out of the bladder.
• Once urine has stopped draining, remove the catheter entirely. The stoma will close as soon as the catheter is removed.

The stoma will be small and not easily noticeable. Emptying the bladder several times per day using the Mitrofanoff channel decreases the chance of urine leaking from the bladder.

After the procedure, many children can empty their bladder without the need to undress — usually without the help of others — for increased independence, confidence, and overall quality of life.

Boston Children’s Department of Urology, one of the largest programs of its kind in the country, treats thousands of patients each year. Our surgeons use advanced methods, such as robotic surgery, whenever possible to ensure our patients experience less pain, shorter hospital stays, and faster recoveries. Our multidisciplinary team will remain involved in your child’s care throughout their recovery, and possibly for years to come, to ensure their ongoing health and well-being.