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Urology leaflets - surgical

Mitrofanoff

The Mitrofanoof procedure creates a channel into the bladder through which a catheter (thin, plastic tube) can be inserted to empty the bladder of urine, instead of passing urine through the urethra. This channel – which looks like an extra tummy button – is usually referred to as a ‘Mitrofanoof’, and is created in an operation under general anaesthetic. Sometimes, this is done during an operation to enlarge your child’s bladder.
In Short
Children who are incontinent (wet) may benefit from this procedure. It allows the bladder to be emptied several times a day, reducing the chance of the bladder leaking urine. It can be psychologically easier and physically less uncomfortable to insert a catheter into the Mitrofanoof rather than the urethra. It can also allow older children to lead a more normal life. The Mitrofanoff procedure is often used for children with bladder problems due to spina bifida, bladder exstrophy or bladder obstruction (posterior urethral valves).

What happens before the operation?

Before your child comes in for the operation, you may want to come to the hospital for a pre- admission clinic. More details about this are in your admission letter. You will already have received information about how to prepare your child for the operation. The surgeon will visit you to explain about the operation in more detail, discuss any worries and ask you to sign a consent form giving your permission for the operation. Another doctor will also visit you to explain about the anaesthetic and options for pain relief after the operation. If your child has any medical problems, particularly allergies and constipation, please tell the doctors about these. Please also bring in any medicines your child is currently taking. Your child may need to have his or her bowel prepared for surgery. This means it will need to be empty of poo. Your child may need to take some medicine (or have an enema if he or she has an existing bowel problem) some time before the operation. During this bowel emptying process, your child will not be able to eat any solid food and only drink clear fluids.

What does the operation involve?

If your child has already had his or her appendix removed or if it is not suitable, the surgeon may need to use a piece of the small intestine to create the channel. The surgeon will disconnect your child’s appendix from its usual position on the large intestine and open it up to form a tube. He or she will then connect one end to a small incision (cut) in your child’s bladder and the other end to another small incision in your child’s abdomen. The surgeon will also create a ‘valve’ where the tube joins the bladder, which squeezes shut as the bladder fills with urine. This will reduce the chance of urine leaking from the Mitrofanoof. Your child will be away from the ward for about three hours, although it may take longer if he or she is having another procedure at the same time, such as bladder augmentation. The usual hospital stay is about seven days.

Your child may also have a suprapubic catheter for a while after the operation, to allow the bladder and Mitrofanoof to heal. During this time, the catheter will be connected to a collection bag, so urine can drain freely from the bladder.

It is quite common for children to have bladder spasms after this type of operation, and also to leak a small amount of urine, which may be tinged with blood. This is quite normal, and we will give you medication to deal with the bladder spasms before you go home. A few days after the operation, paracetamol or ibuprofen will be enough to deal with any remaining discomfort.

Looking after the Mitrofanoff:

The Mitrofanoff needs to be treated as a wound for the first five days. Your child’s nurse will show you how to care for it. After that, you should keep the Mitrofanoff clean by washing it once a day and then patting it dry with a towel. Do not rub the Mitrofanoff as this will make it sore. The Mitrofanoff can shrink a little after the operation, but this usually settles down when you start to use the catheter. On rare occasions, the Mitrofanoff may need stretching while your child is under a general anaesthetic.

Your child should drink fluids as normal. Reducing fizzy drinks and drinks containing caffeine can help reduce any irritation. Cranberry juice is a good drink as it can also help reduce any bladder irritation and infections.

When you get home:

  • You should encourage, but not force, your child to drink.
  • Your child should not have a bath or shower until a scab has formed over the operation site. When a scab has formed, try to avoid long baths as this may cause the scab to soften and fall off too early
  • The operation site may be closed with steri-strips. The steri-strips usually fall off of their own accord. If they have not fallen off within a week, you can soak them off using a wet flannel.
  • To reduce the risk of infection, some children will be given a course of antibiotics to take at home.
  • The doctor will see you roughly three months after the operation. We will arrange the date before you go home.

Starting to use the Mitrofanoof:

About three weeks after the operation, you and your child will need to come back into hospital for a few days to check everything is healing well, have the catheters removed and start to learn how to use the Mitrofanoof. If your child is old enough and physically able, we will teach him or her as well. You will both have a lot to learn about using the Mitrofanoof and it may feel daunting at first, but it will quickly become easier. Your child’s nurse will give you enough supplies to start using the Mitrofanoof. After this, you will need to get further supplies from your child’s GP, community team or embassy team. Remember to order supplies in plenty of time. If you have any problems, please contact the hospital. You or your child should catheterise at least every four hours during the day and before going to bed. Do not leave it for any longer as this increases the risk of infection and/or leakage.

Instructions:

  1. Assemble all the equipment you will need – for example a Catheter and Lubricating jelly (if the catheter is not pre-lubricated)
  2. Wash your hands
  3. Sit or stand your child near the toilet
  4. Lubricate the end of the catheter if necessary
  5. Insert the catheter gently into the Mitrofanoof until you meet resistance and then give it a firm push to guide it further into the bladder
  6. Allow the urine to drain freely
  7. Move the catheter about within the bladder to drain all the urine – it can help if your child coughs while doing this as this tenses the bladder allowing more urine to drain
  8. When urine stops flowing remove the catheter
  9. Dispose of the catheter as you have been taught
  10. Wash your hands

Follow up

Your child will have an outpatient appointment to provide follow up, usually three months after discharge. This appointment is sent to you in the post by the consultant PA or contact the consultant PA to book.

For further information please contact

We hope that you find this information helpful. If you have any questions or problems either before or after the surgery, please do not hesitate to contact, Clinical Nurse Specialist, Paediatric Urology on 020 7580 4400, ex.10838 (09:00 – 17:00 Monday to Friday) or email at: [email protected]

For Out of hours: Contact our Paediatric Site Practitioner via the switchboard on: 02075804400 ex 10843

Disclaimer Whilst this leaflet aims to provide you with useful information, it must be noted that it should only act as a guideline. Should you have any further concerns about this procedure, it is advisable that you discuss them with your Consultant.

Support

There are no support groups specifically for children who have a Mitrofanoof, but the following organisation may be able to offer advice and support. Association for Spina Bifida and Hydrocephalus (ASBAH) 42 Park Road Peterborough PE1 2UQ Telephone: 01733 555988

Mitrofanoof Support:

www.mitrofanoffsupport.org.uk

Website: www.shinecharity.org.uk

Troubleshooting:

You cannot insert the catheter into the Mitrofanoof
· Try to insert the smaller size catheter.

· If you can do this, leave this catheter in place and plug the end using the spigot. Contact the ward for advice.

· If you still cannot insert the catheter, call the ward for advice.
Your child continues to be wet in between catheterisations

· If your child has previously been dry, and suddenly becomes wet again, this could show signs of infection, poor bladder emptying or a change in bladder behaviour. Call the ward for advice.
You or your child notice blood in the urine or catheter

· A small amount of blood is normal especially when you start catheterising.

· If the amount increases or continues for a long time, please call the ward.
Your child’s urine becomes infected

· Signs of infection include darker urine than usual, smelly or cloudy urine.

· Call the ward as your child may need a course of antibiotics.
Your child’s Mitrofanoof is red, inflamed or bleeding

· Passing the catheter into the Mitrofanoof can sometimes cause this, but it usually stops when the catheter is removed

· If this continues, please contact the ward for advice.
Your child’s Mitrofanoof is sore and oozing

· Infections sometimes occur, usually fairly soon after the operation. Contact the ward as your child may need a course

· In the long term, any weeping from the Mitrofanoof is likely to be mucous. This is quite usual.

· You can cover the Mitrofanoof with a small dressing or plaster if the oozing is affecting your child’s clothes.
Urine seems to be leaking from the Mitrofanoof

· Contact the ward as the Mitrofanoof may need checking.

DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.