What is a Mitrofanoff?
A Mitrofanoff (say: me-TROFF-an-off) is a small tunnel from the bladder to the outside of the body. This tunnel is used to empty the bladder with a catheter. A catheter is a small flexible tube that is put into the bladder through the Mitrofanoff.
There are many reasons a child may need a Mitrofanoff, such as:
- birth defects
- trouble or pain with using a catheter through the urethra. The urethra is the tube that normally carries urine (pee) out of the bladder.
A Mitrofanoff is created with surgery (an operation). To make the tunnel, the surgeon will use your child's appendix. The appendix is an unused part of the bowel. The surgeon will take it and re-attach it between your child's bladder and the skin of the belly. This whole procedure is sometimes called a Mitrofanoff procedure or catheterization using a Mitrofanoff.
Use the information on this page to explain to your child what will happen, using language your child understands.
Preparing for the operation
Before any operation, patients often have to do specific things to prepare. Staff at the hospital will tell you what you need to do before the operation. They will give you a brochure or pamphlet to read. If you do not get this information, ask. If you have more questions after reading the pamphlet, ask.
Because the surgeon will cut out your child's appendix, it is important to make sure that your child's bowel is as clean as it can be before the operation. Getting the bowel as clean as possible means restricting what your child eats and having enemas.
Eating and drinking
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, Jello, and freezies. Your child cannot have anything else to eat or drink.
Write the date of your child's operation here:
Write the date your child must start having only clear fluids here:
Your child will need to have several enemas. An enema means that a small tube is put into your child's anus and water is flushed inside. Then, your child will go to the bathroom and expel the water and feces (poo) from the bowel. Usually, enemas are a bit uncomfortable but they do not hurt.
The day of the operation
The day of the operation, your child will be pre-admitted at the Urology Unit. Your child can have only clear liquids to drink.
Your child will be given another enema.
Your child will be given a special "sleep medicine" called a general anesthetic during the operation. This means that your child will sleep and will feel no pain during the procedure.
Mitrofanoff surgery usually takes about 2 hours. Your surgeon will speak to you about this before the surgery.
After the operation
When your child goes back to the unit from the operating room, she will have an intravenous line (IV). An IV is a tiny plastic tube that is placed in a vein in the hand or arm. For the first few days after the operation, your child will get the liquids and medicines she needs through the IV.
Your child will may also have some of the following.
Your child will have a nasogastric tube. The tube usually stays in place for about 1 week. Your child's stomach must stay empty and have a chance to rest after the operation.
Your child will have a suprapubic catheter after the operation. This catheter is a small tube that goes through the skin of the belly into the bladder. All the urine that would normally be stored in the bladder drains out through this tube and into a bag called a urine collection bag.
This catheter will be taken out at the urology clinic, usually about 1 week after the Mitrofanoff operation. Your child will not need an operation to take out the catheter.
Your child may have ureteral stents. These are small plastic tubes that sit in the ureters. The ureters are the tubes between the kidneys and the bladder. The ureteral stents let all the urine drain from the kidneys and give your child time to heal.
Your child will need an operation to take out the stents, usually 6 to 8 weeks after the Mitrofanoff operation.
Your child will have a urinary catheter inside the Mitrofanoff. It may or may not be attached to a urine collection bag.
Incision, stitches, and gauze
Your child's incision will be closed with stitches. The incision is the place where the surgeon cuts through the skin to operate. The stitches will dissolve about 10 days after the operation.
The incision and the stitches will be covered with white gauze. The nurse will change the gauze every day.
A drain called a Penrose drain may be placed in your child's belly, close to the incision. It takes away the extra liquids that may collect during the operation. This drain looks a lot like a thick elastic band. It will be stitched in place and covered with a piece of gauze.
We will take out this drain before your child goes home.
Managing your child's pain
There are several ways to control pain that work well. Which way we use will depend on your child's age and needs.
- Your child may get medicine for pain through the IV.
- Your child may have an epidural catheter. An epidural catheter is a small plastic tube that an anesthesiologist puts into a space in the spine. (The anesthesiologist is the doctor who gives sleep medicine to take away the pain.) The catheter is put in in the operating room. This catheter lets your child have medicine for pain all the time. The epidural catheter works well because it numbs the body below the incision.
- Once your child feels better, she can swallow her pain medicine.
The cause and treatment of bladder spasms
Catheters and stents may bother the bladder and cause cramps, called bladder spasms. Sometimes bladder spasms can hurt a lot. If your child has painful bladder spasms, she will be given a medicine called a B&O suppository. This medicine relaxes the bladder and reduces the pain.
Symptoms of bladder spasms
Signs that your child is having bladder spasms may include:
- pain that comes on quickly and then stops
- an itchy bottom
- the need to urinate or have a bowel movement (poo) often
- your child holding or rubbing her genitals (private parts) more than usual
- urine leaking around the catheter
- drawing the knees up to the chest, especially in babies and toddlers
The nurse will check your child's pain control regularly. But you know your child best. The nurse will want to know if you think your child's pain is being controlled well. If you feel your child is in pain, tell the nurse.
Getting active again
Right after the operation, your child will have to stay in bed all day and all night. Your child may not be allowed to sit up for 1 or 2 days. While your child is lying in bed, she should try to do these things:
- take deep breaths and cough
- exercise her legs
- roll from side to side
The nurse will help.
The doctor will decide when your child is ready to get out of bed. Your child will have to become active slowly. Your child can start by sitting in a chair. Then she can slowly start to walk when she is ready.
Eating and drinking after the operation
Your child's bowel needs to rest after the operation. So your child will not be able to eat or drink for a while. When she begins to feel grumbling in the stomach and passes gas, the doctor will take out the nasogastric tube.
Your child will be allowed only clear liquids at first. She can eat normal food after a few days.
Your child must drink as much liquid as possible. This will help the catheters drain well.
Learning to use the catheter and Mitrofanoff
When your doctor feels that everything has healed, he may decide to send your child home for a short time. Your child will have these 2 catheters:
- a catheter in the Mitrofanoff
- a suprapubic catheter
The nurse will teach you how to look after your child's catheters at home before you leave the hospital.
Before you go home, we will arrange for a home care nurse to visit you at home. This nurse will help you and your child look after the catheters in your home.
The doctor will decide when you should learn how to put a catheter into the Mitrofanoff to drain the urine. This is called catheterization. When you learn to catheterize the Mitrofanoff, your child will return to the hospital for a couple of hours. The nurse will teach you and your child how to do the catheterization.
Most young children who go to school can catheterize their Mitrofanoff on their own. Many children can help care for their own Mitrofanoff, even children who are not going to school yet.
Telling your child's other doctors about the Mitrofanoff
Tell all doctors who take care of your child that she has a Mitrofanoff. Some doctors may not have heard of this before. You may have to explain it to them.
You should also tell the school nurse that your child has a Mitrofanoff.
Your child needs to wear a medic alert bracelet. Before your child leaves the hospital, the nurse will give you the forms to fill out to get this bracelet.
- A Mitrofanoff is a tunnel between the bladder and the outside of the body. This tunnel is used to pass urine through a catheter.
- Your child will need an operation to make the Mitrofanoff.
- After the operation, your child may have other catheters. They will be removed later.
- Your child may have bladder spasms for a few days after the surgery.
- When your child's Mitrofanoff has healed, a nurse will teach you and your child how to use the catheter.