Mitrofanoff appendicovesicostomy 3330022 221286267 2008-06-23T21:25:33Z Nephron 321400 /* Relation to MACE */ wikify Mitrofanoff principle [[Image:Gray536.png|right|300px|thumb|The [[vermiform appendix]] is used in the '''Mitrofanoff procedure'''.]] '''Mitrofanoff appendicovesicostomy''', also known as the '''Mitrofanoff procedure''', is a [[surgical procedure]] in which the [[vermiform appendix|appendix]] is used to create a conduit between the skin surface and the [[urinary bladder]].<ref name=mingin>{{cite journal |author=Mingin GC, Baskin LS |title=Surgical management of the neurogenic bladder and bowel |journal=Int Braz J Urol |volume=29 |issue=1 |pages=53–61 |year=2003 |pmid=15745470 |doi= |url=http://www.brazjurol.com.br/january_february_2003/Baskin_ing_53_61.htm}}</ref> ==Description of procedure== In the procedure, the [[surgeon]] separates the appendix from its attachment to the [[cecum]], while maintaining its [[appendiceal artery|blood supply]]. Then he creates an opening at its blind end and washes it. One end is connected by [[suture]]s to the urinary bladder and the other is connected to the skin to form a [[stoma]]. Generally, an incision is made into the [[umbilicus]] (belly button) so that it may serve as the canal for the catheter. Urine is typically drained several times a day by use of a catheter inserted into the Mitrofanoff canal. ==Indications== The procedure is typically performed when there is a blockage of the normal outlet (as in [[urethral cancer]]) or when there is a need for frequent, often uncomfortable, [[foley catheter|catheterizations]] (as in [[neurogenic bladder]]). The most common patients who undergo this procedure are those who are dependent on catherization to eliminate urine, such as [[paraplegic]] individuals (typically those born with [[spina bifida]]). The Mitrofanoff procedure allows the individual to self-cath so that he or she is not dependent on a family member or a medical professional to catherize him or her. The Mitrofanoff procedure has been found to improve the life of people with [[spinal cord injuries]], by increasing their independence.<ref>{{cite journal |author=Merenda LA, Duffy T, Betz RR, Mulcahey MJ, Dean G, Pontari M |title=Outcomes of urinary diversion in children with spinal cord injuries |journal=J Spinal Cord Med |volume=30 Suppl 1 |issue= |pages=S41–7 |year=2007 |pmid=17874686 |doi= |url=}}</ref> ==Relation to MACE== The ''[[Malone antegrade continence enema]]'' (MACE), used to treat [[fecal incontinence]], is like the Mitrofanoff procedure as it uses the ''[[Mitrofanoff principle]]'' and, thus, can be considered an analogous procedure. As fecal and urinary incontinence frequency co-exist, a MACE is often created at the same time as a continent [[urinary catheter|catheterizable]] urinary conduit.<ref>{{cite journal |author=Teichman JM, Rogenes VJ, Barber DB |title=The utility of the Malone antegrade continence enema for urologists |journal=Tech Urol |volume=3 |issue=1 |pages=30–3 |year=1997 |pmid=9170222 |doi= |url=}}</ref> ==Relation to Monti procedure== If the [[vermiform appendix]] is not available, due to [[appendectomy]], or unusable for another reason, the [[Monti procedure]] is done.<ref>{{cite journal |author=Shapiro E |title=Early clinical experience with monti procedure and managing the nonpalpable testis in children |journal=Rev Urol |volume=1 |issue=2 |pages=94–6 |year=1999 |pmid=16985779 |doi= |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16985779}}</ref> ==References== {{reflist}} ==External links== * http://www.medscape.com/viewarticle/410216 [[Category:Surgical procedures]] [[Category:Urology]]