Митрофановская операция: создание альтернативного пути оттока мочи.

The Mitrofanoff procedure, also known as the Mitrofanoff appendicovesicostomy, is a surgical procedure in which the appendix is used to create a conduit, or channel, between the skin surface and the urinary bladder. The small opening on the skin surface, or the stoma, is typically located either in the navel or nearby the navel on the right lower side of the abdomen. Originally developed by Professor Paul Mitrofanoff in 1980, the procedure represents an alternative to urethral catheterization and is sometimes used by people with urethral damage or by those with severe autonomic dysreflexia. An intermittent catheter, or a catheter that is inserted and then removed after use, is typically passed through the channel every 3–4 hours and the urine is drained into a toilet or a bottle. One end of the channel is sewn to the skin, creating an opening on the surface called a stoma.

If the appendix is not available, due to appendectomy, or unusable for another reason, the Monti procedure is done.

If the bladder is not sufficiently large, some people may need a bladder augmentation at the same time as a Mitrofanoff. Augmentation enlarges the bladder, making it possible to hold more urine and prevent backflow into the kidneys. Neobladders are usually created in instances of bladder removal. Mitrofanoff's concept revolutionized clean intermittent catheterization because it allows urine to be drained via a route other than the urethra. in Philadelphia. but Duckett advised against the closure of the bladder neck. For people who would otherwise leak via the urethra, the Mitrofanoff channel can provide continence and enable them to stop using diapers. Appropriate candidates are prepared to commit to a lifetime of followup care. Also contraindicated are those who cannot hold large volumes of urine without refluxing into the kidneys.

People who have been determined to be candidates for a Mitrofanoff surgery will need to undergo a variety of presurgical tests. Testing often includes blood tests such as a complete blood count, a basic metabolic panel, and an assessment of cystatin c. Bowel prep is done to reduce infection risk.

The Mitrofanoff procedure is a major surgery and typically requires inpatient hospitalization for 5–7 days. Initially, eating and drinking by mouth is not permitted and fluids are delivered intravenously for a few days. Progression to a regular diet can be accomplished, starting with the consumption of clear fluids. A tube is typically also placed in the urethra or through a suprapubic opening to ensure full urine drainage and to rest the bladder during recovery. Full recovery time varies from person to person and ranges from 3–12 months.

There are three major types of intermittent catheters used with a Mitrofanoff. Intermittent catheters are used to drain the bladder at regular intervals. Drinking plenty of fluids is recommended to flush out the kidneys and bladder and to lessen the chance of urinary tract infection. For this time period, physical education and activities such as bicycle riding are not advisable. Bladder stones can stop the bladder from emptying completely during catheterization and cause infection. Left untreated, bladder stones can cause infection. Additional surgery may be required to ensure the safe insertion of a catheter. Urinary tract infections: Urinary tract infections can be a concern in people who use catheters due to incomplete emptying or catheter contamination from the hands. They can be prevented with proper fluid intake and careful hand hygiene.