The Mitrofanoff Procedure: A Continent Diversion for Bladder Management After Spinal Cord Injury

• POSTER PRESENTATION:

The Mitrofanoff Procedure: A Continent Diversion for Bladder Management After Spinal Cord Injury

Spinal Cord Injury (SCI) can result in a neurogenic bladder which produces significant changes to the function of the urinary bladder and bladder outlet. The primary goal in the urologic management of the SCI patient is to maintain renal function and prevent high pressures in the bladder that can lead to upper tract damage and hydronephrosis. The Mitrofanoff procedure can greatly enhance the quality of life for males and females with SCI by providing them with a continent urinary stoma.

The Mitrofanoff surgical procedure:

• appendix is separated from the cecum (a ureter or piece of bowel may also be used)
• appendix is reversed and anastomosed to the (often augmented) bladder in a nonrefluxing fashion
• other end of the appendix is  brought onto the abdominal wall or through the umbilicus to form a stoma

Advantages of intermittent catheterization via the Mitrofanoff after SCI include:

• allows patient easy stoma access without needing to undress 
• allows patient to catheterize who have limited hand function
• decreases need for wheelchair transfers that lead to rotator cuff strain and impingement issues
• avoids the need to wear an ostomy pouch over the stoma to collect urine
• decreases time needed to catheterize in many patients
• increases bladder capacity after augmentation

Disadvantages of intermittent catheterization via the Mitrofanoff after SCI include:

• potentail for skin breakdown due to Mitrofanoff leakage
• potential need for surgical revision of the Mitrofanoff
• need to be motivated to catheterize stoma at regular intervals

Bladder management should be individualized  to optimimize the patient's personal preference. Bladder access through a continent stoma is one such option and is associated with early recovery, early resumption of normal activities, and excellent cosmesis.

A case study will be presented to exemplify the benefits of the Mitrofanoff in one SCI female.