What is the Mitrofanoff Procedure? Let's talk about it simply.

Sometimes we have to face health problems that we can't even imagine. Especially when it comes to bladder problems, it's very difficult to not be able to urinate normally. Living with such conditions is a big challenge for both a child and an adult. To help such people, today we are talking about a special surgery that is done to make their lives easier. This is called the Mitrofanoff Procedure. Although the name is a bit strange, the benefits of this are very valuable.

Simply put, what is this Mitrofanoff surgery?

Mitrofanoff surgery is a surgical procedure that creates a small opening (called a stoma ) in the abdomen to allow urine to drain from the bladder. This is a very special procedure because surgeons use a part of your own body to create this opening. That is your appendix .

Imagine, using your scrotum, you create a small tube-like passage from your bladder to your abdomen. Then, when you need to urinate, you can insert a catheter , a flexible tube, through this opening (stoma) to empty your bladder.

This procedure was first introduced in 1976 by a professor named Paul Mitrofanoff. That's why it got its name. It is also called `appendicovesicostomy`.

Let's first understand a little about these parts of our body.

To fully understand this surgery, it's helpful to have a little idea of ​​how our body's urinary system and ureter work.

• Bladder: This is a muscular sac that looks like a balloon. The urine that our kidneys make from filtering blood flows through two small tubes (ureters) and collects in this bladder. When it is full, we feel the need to urinate. Then, the urine leaves the body through the urethra.
• Appendix: This is part of our digestive system. It's a small tube that's located on the lower right side of your stomach, attached to the first part of your large intestine. Doctors still don't know what other function it has. But we can live a healthy life without it. Many people have it surgically removed when they get appendicitis. So, there's no problem with putting it to other useful uses.

Imagine if you don't have an appendix, meaning it was removed in a previous surgery, what would you do? There is a solution for that too. In that case, the surgeon takes a small piece of your small intestine and creates this passage. It's called the Monti or Monti-Yang procedure.

What actually happens during a Mitrofanoff operation?

This allows you to empty your bladder yourself by inserting a catheter through a hole in your abdomen (stoma). This is called self-catheterization .

Throughout the day, at specific times (usually every 3-4 hours), you will need to do the following:

1. A flexible tube (catheter) is inserted through the opening (stoma) in the abdomen and guided along the created path to the bladder.

2. All urine is emptied into the toilet or a container along the pipe.

3. Once the bladder is completely empty, the catheter is removed. The opening (stoma) then closes automatically. No urine leaks from there.

This method is easier, less painful, and more comfortable for many people than inserting a catheter through the normal urethra.

Who needs this surgery?

Mitrofanoff surgery may be necessary for both children and adults. We will look at both of them separately.

Why does a child need Mitrofanoff surgery?

Some children are born with certain weaknesses in their nervous system. This causes them to be unable to control their bladder muscles. This is called neurogenic bladder . Also, children who have congenital urinary system abnormalities may need this surgery.

Common reasons why children need this surgery are:

• Spina Bifida: A weakness of the spine that is present at birth.
• Bladder exstrophy or cloacal exstrophy: Exposure of the bladder to the outside due to incomplete formation of the abdominal wall at birth.
• Cerebral Palsy: A condition that affects body movements and muscle control due to damage to the brain.
• Sacral agenesis: The congenital absence of the lowest part of the spine.
• Spinal cord injury.

Why does an adult need Mitrofanoff surgery?

Adults may also be unable to control their bladder for various reasons.

• Cancer conditions: Conditions such as bladder cancer, prostate cancer, or colorectal cancer.
• Inability to control urine: Severe urinary incontinence.
• Inflammation of the bladder (Cystitis).
• Nervous system diseases: Neurogenic bladder caused by conditions such as multiple sclerosis or Parkinson's disease.
• Spinal cord injuries, paralysis, or spinal tumors.
• Stroke.

What happens before, during and after the surgery?

It's normal to feel a little scared when talking about a major surgery like this. But knowing exactly how these things happen can help reduce that fear.

Before the procedure

To reduce the risk of infection during surgery, your bowels should be as empty as possible. This requires following your doctor's instructions exactly. These may include:

• Fasting the day before surgery.
• Taking a special drink to completely cleanse the intestines (bowel cleanse).

During the procedure

This surgery is performed under general anesthesia . This means that you will not feel anything during the surgery, and you will be completely asleep.

The surgeon follows these steps:

1. An incision will be made in your abdomen.

2. The appendix is ​​separated from the large intestine.

3. One end of it is connected to a small incision made in the bladder, and the other end is connected to a small hole (stoma) made in the skin of the abdomen.

4. A valve -like structure is created where the ureter connects to the bladder to prevent urine from flowing backward. This valve tightens and closes when the bladder fills, preventing urine from leaking through the created passage.

5. To help you pass urine until your bladder heals, a temporary tube (suprapubic tube) is placed directly into your bladder. This collects urine in a bag outside your body.

6. Sometimes, small tubes (ureteral stents) can be placed in the tubes that carry urine from the kidneys to the bladder (ureters). This is not necessary for everyone.

7. Finally, the main incision made for the surgery is closed with dissolvable stitches.

After the procedure

After the surgery, you will need to stay in the hospital for about a week. During this time:

• You will not be allowed to eat for several days. Instead, you will be given IV fluids. This is to give your intestines time to heal.
• For the first day or two, you will have to lie flat in bed. You will be able to roll over and move your legs, but you will not be allowed to sit up.
• When you go home, a catheter and a temporary `suprapubic` tube will be placed inside the newly created passageway (Mitrofanoff tunnel) to prevent it from closing. This catheter will need to be left in place for about 4 weeks.
• If those `ureteral stents` are placed, another small procedure will have to be done to remove them in about 6-8 weeks.
• On the day you are taught self-catheterization, the doctor will remove both temporary tubes in the office. This does not require another surgery.

What are the benefits and risks of this surgery?

As with any medical procedure, there are benefits as well as some risks.

Recovery and life after surgery

In the first few weeks after surgery, you may experience:

• Small amounts of blood in the urine (hematuria).
• Painful contractions of the bladder muscles (bladder spasms).

Your doctor will prescribe painkillers and muscle relaxants for these.

After about 6 weeks, you will need to see your doctor to learn how to insert the catheter yourself (self-catheterization).

However, you should always pay attention to the functioning of your urinary system. You should have the following tests done annually:

• Blood tests to check the level of electrolytes in the blood and kidney function.
• Cystoscopy (examination of the inside of the bladder).
• Ultrasound scans of the kidneys and bladder.
• X-ray examinations of the kidneys, bladder, and urethra.

When to see a doctor immediately

If you experience any of these symptoms, you should call your doctor immediately :

• Inability to completely empty the bladder.
• Excessive bleeding, swelling, or bruising.
• Nausea and vomiting.
• Severe pain.
• Signs of an infection, such as a foul-smelling discharge or fever.

What is the difference between Mitrofanoff and Urostomy?

Both of these methods involve passing urine through a hole in the abdomen. However, with a urostomy , a path is created to bypass the bladder and directly drain urine from the kidneys. Some people with a urostomy have to wear a urine collection bag at all times. This means they can't control their urine flow. However, with a Mitrofanoff, you have more freedom because you can only empty your bladder with a catheter when you need to.

Is this surgery permanent?

This can be reversed. That is, the tunnel can be surgically removed. However, the appendix is ​​not reconnected to the intestine, as it is not a vital organ. After a Mitrofanoff is removed, you may need to urinate normally through the urethra, or you may need to have a catheter inserted through it to empty your bladder, or you may need to have a urostomy. This is something you should discuss with your doctor.