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 made with surgery (an operation). The opening on the outside of the body is called a stoma.
Right after the operation, your child will have a tube that drains urine (pee) from the bladder. This is called a suprapubic catheter. A catheter is a thin, soft tube.
Later, you and your child need to learn how to use a different kind of catheter. This catheter drains urine through the Mitrofanoff. You will put it in every time your child's bladder needs to be emptied.
A nurse will teach you and your child how to catheterize the Mitrofanoff. This page also explains what to do.
You and your child will learn how to catheterize the Mitrofanoff at the clinic
Your doctor will decide when it is time for you and your child to learn how to put a catheter into the Mitrofanoff. This is called catheterization (say: CATH-uh-ter-ize-AY-shun). You and your child will be scheduled for a follow-up visit to the Urology Clinic to learn how to catheterize through the Mitrofanoff by one of the clinic nurses.
When you and your child are comfortable doing catheterization, a nurse will take out your child's suprapubic catheter.
Catheterization: step by step
Before your child goes home, a discharge planner will tell you what supplies you will need and where to buy them. You will need these supplies:
- a catheter
- a jelly called a water-soluble lubricant. A lubricant makes things slippery.
- a clean face cloth
- a clean bottle
- a syringe that holds 60 ml (about 2 ounces). A syringe is a hollow tube with a plunger that holds liquids.
- a special salt water mixture called normal saline
Catheterizing the Mitrofanoff
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Arrange all the supplies you will need. Wash your hands.
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Use a clean cloth and water to clean the skin around the opening in your child's belly. This opening is called the stoma. Put the lubricating jelly on the end of the catheter.
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Slide the catheter into the stoma. You will find that the catheter is a little harder to move just before the urine starts to drain. Let the urine drain from the catheter into the toilet or a bottle until no more urine comes out.
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If you need to flush the bladder, put the amount of normal saline as recommended by your doctor into the catheter with a syringe. Let the saline drain out, along with any other urine that is still in the bladder.
Not all children need to flush the bladder. Irrigations and flushings are ordered by the doctor. Ask your doctor if your child needs to follow this step.
You may also use room-temperature pre-boiled tap water for irrigations and flushings. Normal saline can be expensive and so pre-boiled room temperature water can be a cost-effective solution. Both pre-boiled water and opened saline must be discarded after 24 hours due to the risk of infection.
Take out the catheter. Wash it well with soap and water, and rinse it well. Then let it air-dry completely and store it in a clean case or a plastic bag. Wash your hands.
Your child will need to be catheterized several times per day
Catheterization is usually done every three or four hours during the day. But your child may need to empty their bladder more often if they have been drinking a lot of liquids.
Your child may or may not have to be catheterized at night.
Before you go home, the nurse or doctor will give you a list of times to catheterize. Write the times here:
How to clean the catheters
Using the same catheter puts your child at risk for urinary tract infections, especially at the beginning when you or your child is still learning how to do a catheterization. Ask your doctor or nurse how many times you can use the same catheter.
Keeping the catheter clean and germ-free will help prevent urinary tract infections. There are two steps to keeping your catheters clean, which are described below. Step 1 should be done after each time the supplies are used. Step 2 should be done once a day for sterilization. This means any germs on the catheters are removed, which helps prevent your child from getting an infection. There are two options for sterilization: boiling in water, or soaking in vinegar.
Step 1: Cleaning the catheters (just after using)
- Wash catheters with a warm, soapy water and rinse well, inside and out.
- Liquid hand or dish soap works well and is safe.
- You can also use a syringe to flush the catheter. A syringe is a hollow tube with a plunger.
- Dry the catheter with a towel and store it in a plastic bag labelled "dirty" to be sterilized later in the day.
- Go to Step 2: either Option 1 or 2.
Step 2: Sterilizing (once per day)
The nurse will tell you if you need to sterilize the catheters by boiling or if you can sterilize with vinegar only.
Option 1: Sterilizing by boiling
- Once a day put all the washed catheters in a large pan of hot boiling water for about 10 minutes.
- Do not forget to take the catheters out or the catheter will be damaged.
- Then place catheters on a clean paper towel to air dry. It is important not to have any wet spots or any moisture inside the catheter because this will be a good area for germs to grow.
- Store the catheters in a clean zip-lock plastic bag or container in a safe place.
- The same catheter can be reused and cleaned for about a week unless it becomes rough, stiff, cracked or damaged in any way.
Option 2: Sterilizing with vinegar
- Wash the catheters with warm, soapy water.
- Rinse thoroughly two times.
- Soak catheters in a solution of about one cup of vinegar in a basin of room temperature water for about 30 minutes.
- Rinse catheters with clean water.
- Put catheters on a clean paper towel to air dry. It is important not to have any wet spots or any moisture inside the catheter. Germs could grow in these damp places.
- Store the catheters in a safe place in a clean zip-lock plastic bag or container.
- The same catheter can be reused and cleaned for about a week unless it becomes rough, stiff, cracked or damaged in any way.
Your child can go in the water
Your child will not need any special care when they take a bath or swim.
Your child should wear comfortable clothes
Your child should wear anything that is comfortable. They do not need to wear gauze or a dressing over the stoma. There should be no urine leaking from it.
Tell your child's other doctors that your child has a Mitrofanoff
Tell all the doctors who take care of your child that they have a Mitrofanoff. You should also tell the school nurse. They need this information to look after your child.
Your child should wear a medic alert bracelet. A medic alert bracelet lets health care workers know of your child's Mitrofanoff if there is an emergency. Before your child leaves the hospital, the nurse will give you the forms to fill out to get this bracelet.
When to call the doctor
Call your child's doctor if any of these things happen:
- Your child has trouble emptying their bladder, even after they try flushing it.
- You or your child has trouble putting the catheter in. Never try to force the catheter. It should go in easily.
- You see any liquid leaking from the stoma.
- You see any signs of infection. These include cloudy or smelly urine and fever. Your child should drink lots of liquids to help keep the urine clear and protect against infection.
Write the doctor's phone number here:
At SickKids
Supporting your child
When preparing your child for an operation, the urology team recommends that whenever possible, your child and family members attend the Pre-Admission Program offered at Sick Kids. For more information call 416-813-6150 or visit the website at www.sickkids.ca
A Child Life Specialist can also help to prepare and support your child if they are anxious about the operation.