From the Guidelines
A Mitravanoff is a surgical procedure that involves creating a catheterizable channel to the bladder, often using the appendix, to improve urinary continence and independence in patients with neurological or anatomical disorders. This procedure is commonly performed in conjunction with other surgeries, such as the Malone Antegrade Continence Enema (MACE) procedure, to address both urinary and fecal incontinence issues 1. The Mitravanoff procedure allows for improved social confidence, hygiene, and independence, especially when combined with other treatments for fecal incontinence, such as antegrade enemas 1. Some key points to consider about the Mitravanoff procedure include:
- It is often used in patients with spina bifida or other conditions that affect bladder control
- The procedure can be performed using the appendix or other tissues to create a catheterizable channel
- It is typically performed in conjunction with other surgeries, such as lower urinary tract reconstruction
- The goal of the procedure is to improve urinary continence and independence, reducing the impact of incontinence on quality of life 1. In patients undergoing lower urinary tract reconstruction, it is essential to address fecal continence issues and consider performing a concomitant MACE procedure, as described by Tackett et al, who used a technique where the appendix can be split into 2 segments for use in both procedures 1.
From the Research
Definition of Mitravanoff
- The Mitravanoff procedure, also known as the Mitrofanoff procedure, is a surgical technique used to create a continent catheterizable stoma for urinary diversion 2, 3, 4, 5.
- The procedure involves the creation of a conduit that connects the bladder to the skin, allowing for clean intermittent catheterization and providing continence 3, 5.
Purpose and Application
- The Mitravanoff procedure is used to manage intractable urinary incontinence in patients with neurogenic bladder, spinal lesions, bladder exstrophy, and other conditions 2, 4, 6.
- The procedure can be combined with other surgical techniques, such as antegrade continence enema, to address both urinary and fecal incontinence 6.
Surgical Techniques and Outcomes
- Various tissue segments, including the appendix and Yang-Monti transverse ileal tube, can be used to create the conduit 2, 5.
- The procedure has an early reoperation rate of up to 8% and a long-term complication rate of up to 32%, with stomal stenosis being the most common complication 5.
- Reports suggest that the procedure is durable and provides good outcomes in both pediatric and adult patients, with 15 out of 18 patients in one study achieving satisfactory results 6.