Mitrofanoff procedure

The Mitrofanoff procedure, also known as appendicovesicostomy, is a surgical procedure where a conduit is created using the appendix to form a connection between the urinary bladder and skin surface. Intermittent catheterization is performed through the surgically constructed conduit, thus providing an alternative to urethral intermittent catheterization in patients who are unable to tolerate the latter ^1,2.   

The procedure was initially intended for children with adequate bladder capacity but without functioning urethral capacity, however the indications have subsequently been extended. It is most commonly performed in younger patients with congenital urological anomalies or intractable bladder dysfunction.

Procedure

The appendix is used to create a channel between the bladder and the skin surface. A valve is constructed using tissue to prevent urine leakage in between cathterisations.  In some cases, a segment of descending colon is detubularised, closed, folded, and anastomosed to the ureters to create a low-pressure reservoir, thus bypassing the urinary bladder ³. The stoma is typically located at the umbilicus or in the right lower quadrant ⁴. 

In cases where it is not possible to use the appendix, a short segment of the small intestine can instead be used to produce the same outcome. This is called a Monti procedure ⁴. 

Where bladder capacity is limited, the procedure may be performed in conjunction with bladder augmentation.

Radiographic features

Fluoroscopy

A contrast enema of the pouch will demonstrate the passage of contrast in the reservoir. It can be used to detect strictures or leaks. 

CT

The urinary bladder or colonic reservoir may contain gas bubbles due to intermittent self catheterization. In cases of a colonic reservoir, hypoattenuating material may also be seen within the reservoir due to mucous bowel secretions ³. 

Complications

• urine leak from the anastomosis

• abscess formation

• fistula formation

• strictures

• pyelonephritis

• urolithiasis (frequent, due to chronic bacterial infection associated with intermittent catheterization and urinary stasis)

History and etymology

The Mitrofanoff procedure was first described in 1980 by Professor Paul Mitrofanoff ⁵.