Mitrofanoff Procedure • 1980 Mitrofanoff reported use of appendix to attain continence in 16 children • Produced a continent catheterizable vesicostomy stoma • Implanted appendix into bladder wall via a subepithelial antirefluxing tunnel • In conjunction with closure of the bladder neck
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Mitrofanoff Procedure
• 1980 Mitrofanoff reported use of appendix to attain continence in 16 children
• Produced a continent catheterizable vesicostomy stoma
• Implanted appendix into bladder wall via a subepithelial antirefluxing tunnel
• In conjunction with closure of the bladder neck
Mitrofanoff Procedure
Mitrofanoff Procedure
• Originally intended for children with
adequate bladder capacity without
functional urethral access
• Modified to include bladder augmentation
when small capacity poorly compliant
bladders (Weisgerber)
• Duckett & Snyder (1986) ileocecal reservoir
with appendiceal stoma
Mitrofanoff Procedure
• Technique:
– Appendix mobilized on mesentery preserving
blood supply
– Bladder neck transected and closed unless
external sphincter is competent (pop off valve)
– Appendix implanted into 4 - 5 cm subepithelial
tunnel
– Bladder augmentation used when capacity
limited
Mitrofanoff Procedure
• Technique:
– Bladder is anchored to anterior abdominal wall
to ensure ease of catheterization
– Appendix base is exteriorized and sutured to
skin
– Appendix intubated with 12F catheter for 2
weeks
Mitrofanoff Procedure
Mitrofanoff Procedure
• Indications for Mitrofanoff
– Intractable incontinence due to:
• Neuropathic Bladder
– Spinal Dysraphism
– Spinal Neuroblastoma
• Genitourinary Malformations
– Imperforated Anus
– Cloacal Anomalies
– Exstrophy - Epispadias Complex
Mitrofanoff Procedure
• Mitrofanoff reviewed long term results with
continent vesicostomies minimum 15 year
follow-up in 23 patients. 20 appendices, 2
ureter, 1 bladder tube
• Bladder augmentation 2 simultaneously, 8
later secondary procedure
• 5 patients had vesicoureteric reflux
Mitrofanoff Procedure
• Results:
– 1 death - post op infection - VP Shunt infection