Although this is a bowel management web site, we know that bladder surgeries are usually performed right alongside bowel surgeries and that parents and adults have a lot of questions about their options. Below is a brief overview of the most common surgeries to give you a background for speaking with your urologist.
The Mitrofanoff procedure, named after Paul Mitrofanoff, uses the same concept as the MACE and is often performed at the same time. The appendix is used to create a channel between the skin (often in the belly button) and the bladder. If the appendix is large enough, the surgeon can use part of it for the Mitrofanoff and part for the MACE.
If the appendix is not available because it was removed due to appendicitis or it was already used for the MACE, the surgeon will instead perform a Monti procedure. In this case the surgeon uses a piece of the gastrointestinal tract, a portion of the ileum, to create the channel.
The goal for either procedure is for an individual to be able to catheterize their bladder from their belly. This may be desired because catheterizing through the urethra is painful, the individual doesn’t have the fine motor dexterity to catheterize themselves the old fashioned way, or because they cannot independently transfer to a toilet, undress, and support themselves to cath. One can remain in a wheelchair and simply pull up their shirt to catheterize. In these situations, the Mitrofanoff or Monti promotes the individual’s independence in caring for themselves while maintaining a healthy bladder.
The Mitrofanoff/Monti do not necessarily improve bladder health or continence. But there are a variety of other surgeries that can, if regular cathing with or without medication does not.
A bladder augmentation can be performed when someone’s bladder is too small or rigid to hold a normal amount of urine (which causes leaking or reflux into the kidneys). A surgeon uses a piece of the small intestine to expand the bladder and decrease bladder pressure. The intestines secrete mucous, so when a piece is attached to the bladder it will continue to secrete mucous into the bladder. Therefore in addition to cathing, one must irrigate the bladder daily to remove the mucous or else bladder stones and UTI’s can develop.
When the bladder can hold a decent amount but an incompetent sphincter still leaks, the urologist may recommend a bladder neck sling. Tightening and repositioning the bladder neck/urethra can often increase resistance enough so the bladder doesn’t leak between catheterizations. Alternately, an artificial sphincter filled with fluid may be implanted around the bladder neck to tighten it and prevent urine leakage. In either case, frequent catheterization becomes even more important because urine no longer has an easy way out of the bladder–which can cause kidney reflux or bladder perforation.
A last resort to achieve bladder continence is a bladder neck closure. If the bladder neck is closed off completely, the person cannot leak urine. This makes it absolutely necessary to catheterize through a Mitrofanoff/Monti at regular intervals forever.
Next: More Poop Info