What Is the Mitrofanoff Procedure for Children?

Medically Reviewed by Dan Brennan, MD on July 23, 2022
Written by Parang Mehta
5 min read

Children who have a disorder that prevents bladder emptying need a way to keep their bladder from being constantly full, getting infected, or damaging their kidneys as the result of backflow (reflux). 

A vesicostomy drains the bladder and protects the kidneys. Children who undergo this procedure have to wear diapers indefinitely, though. Additionally, they will often smell like urine, making social interaction embarrassing. 

The Mitrofanoff procedure, also called an appendicovesicostomy, grants dignity and a better quality of life to children with bladder disorders. It provides children with control over their bladders and improves their lives immensely.

Children who cannot empty their bladder on their own are at risk for frequent urinary tract infections (UTIs), urinary reflux, and kidney damage. Kidney damage can cause hypertension (high blood pressure), end-stage renal disease (ESRD), and renal failure. Affected children have three options to empty their bladder and protect their kidneys:

Clean intermittent catheterization. A catheter is a slim tube that is inserted through the urethra into the bladder. This allows urine to drain out. Your child can choose when to insert the catheter, but some boys find it painful and avoid it. Girls often find it difficult because of their anatomy.

Vesicostomy. This is a surgical solution, but a temporary one. The surgeon opens the bladder, making a cut in the abdominal wall. The bladder wall is sewn to the abdominal wall. This allows constant drainage of urine from the opening. Urine does not collect in the bladder, and the kidneys are safe from reflux and pressure damage. As your child grows older, though, they won't like the constant diaper wearing necessary with a vesicostomy. The smell of urine is also terrible for a sensitive child. 

Mitrofanoff procedure. This is a procedure for continent urinary diversion (CUD). It gives your child control over their bladder emptying. Though the urinary bladder has an opening on the abdomen, your child can stay dry without diapers. They can empty their bladder at intervals by passing a catheter through the surgical incision into the bladder. The passage self-seals when the catheter is removed. Most children who undergo the procedure can lead a normal life and engage in everyday activities.

The bladder stores urine produced by the kidneys until it can be expelled. Some children are unable to empty their bladder because of nervous system disorders or anatomical defects. Pressure then builds up in the bladder, forcing urine to travel back up the ureters to the kidneys. This can damage the kidneys. Urinary reflux is also associated with repeated urinary tract infections, which further damage the kidneys. 

Some reasons to seek a Mitrofanoff procedure are: 

Spina bifida. A baby's spine and spinal cord do not develop properly during fetal life. The most common type is spina bifida occulta, which has no visible defect outside the body. The nervous control of the bladder is disrupted, and your child may be unable to empty their bladder. You may also notice weakness or paralysis of the legs and difficulty controlling bowel movements.

Neurogenic bladder. The nervous system controls both the muscle of the bladder (detrusor vesicae) and the sphincter that opens to allow urinary flow. Some nervous system disorders can cause a failure of bladder emptying. These nerves can be affected by injury or disease. Your child might have incontinence (an inability to control urination) or retention (inability to pass urine).

Other conditions. Complex urinary strictures which cannot be relieved by surgery, idiopathic dysfunctional bladder, and prune belly syndrome are some conditions that cause bladder dysfunction. Affected children could benefit from a Mitrofanoff procedure.

Immediate relief is provided by passing a catheter into the bladder. Indwelling catheters can be left in for several days at a time but generate a high risk of UTI. 

At young ages, a vesicostomy provides a temporary solution. As your child grows older, you may opt to close the vesicostomy and opt for clean intermittent catheterization or the Mitrofanoff procedure.

This is a complex procedure and can be done via open surgery or through laparoscopy (minimally invasive surgery). 

For this procedure, the surgeon: 

  1. Opens the abdominal wall or inserts the laparoscope
  2. Cuts the appendix away from the intestine, preserving its blood supply 
  3. Attaches one end of the appendix to the bladder, then attaches the other end to the abdominal wall, either at the belly button or in the lower belly.
  4. Creates openings at both ends of the appendix tube 

After the healing period, which lasts a few weeks, your child can insert a catheter into the opening on the abdomen and into the bladder. The bladder can thus be emptied at select intervals. 

Here are some benefits of the Mitrofanoff procedure:

  • Your child can stay dry without diapers.
  • The opening in the belly button or lower abdomen can't be easily seen.
  • Your child doesn't have to live with the smell of urine.
  • Your child can empty their bladder more conveniently than with a urethral catheter.
  • Unlike indwelling catheters, the risk of infection is low.

There are also, however, drawbacks of the Mitrofanoff procedure: 

  • Your child will need general anesthesia, which comes with risks.
  • There may be bleeding inside the abdomen.
  • The Mitrofanoff procedure is major surgery and requires several weeks for recovery.
  • The procedure requires commitment to regular bladder emptying by catheter. Without it, the kidneys could suffer damage.  

As your child grows, the appendix tube may require revision surgery.

The tube may narrow, not allowing a catheter to pass. A second procedure will be needed.

The channel may become wide, allowing leakage of urine.

The Mitrofanoff procedure was originally developed for children but is also useful for adults. The method is much the same unless you've had your appendix removed previously. Then, your surgeon will use a part of your colon (large intestine) to create a tube from your bladder to your abdominal wall. 

If you're not comfortable with passing a catheter through the urethra, this surgery provides an alternative route that does not require you to wear diapers. 

The Mitrofanoff procedure is a complex surgery. It has a small failure and complication rate and allows children and adults with bladder dysfunction to keep their kidneys safe and lead a normal, dignified life. Frequently, it enables a better quality of life than a vesicostomy.