**3.2 Mitrofanoff**

282 Urinary Incontinence

until the urine collecting bag is full. Changing a collecting bag is incomparably easier than catheterizing a Mitroffanof channel and may significantly facilitate the caregiver's task. Surgical feasibility of the desired urinary derivation must be assessed taking into account:

A patient who has undergone a previous laparotomy is at risk of adhesions which can confer risk of intertinal injury and difficulty intraoperatively. If a Mitroffanof procedure is planned the presence or absence of cecal appendix will dictate whether a small bowel segment will be needed instead. In patients with previous enteric resection the residual bowel segments care must be taken not to leave the patient at high risk of a malbsorption

With abdominal scars the resultant stoma must be fashioned without risk of ischaemia to the skin flap. Any associated abdominal wall defects will also require attention with wound

Ileal conduit externalization may be challenging in obese patients. It is important to properly anticipate the adequate intestinal loop length to assure its passage through the abdominal wall and subcutaneous tissue and also to invert the mucosal end providing an elevated "volcano-like" border. This will allow urine to flow right into the collecting bag,

When externalizing a catheterizable channel, using the umbilicus may overcome the large

Finally, quality of life anticipation will be most closely met when detailed preoperative planning is made in order to understand patients' expectations and the attending team is able to anticipate and clarify the patient how his routine will be with the chosen urinary diversion (frequency needed to catheterize or exchange the collecting device; changes in his

The available surgical technique can be divided into continent catheterizable channels (Mitrofanoff procedure and Yang-Monti technique) and incontinent conduits (Bricker procedure and ileovesicostomy). Cutaneous ureterostomy is no longer used in current

The principle of continent urinary diversion (Mitrofanoff principle) is similar to the one which prevents vesicoureteral reflux: to create a submucosal conduit that colapses whenever the reservoir is full preventing urinary leakage through the diversion. This is attained via a Mitrofanoff channel which is a small calibre tube that provides external access to the bladder. Clean intermittent catheterization allows for proper reservoir

This type of diversion can benefit patients with refractory urinary incontinence along with a procedure to increase the bladder outlet resistance without incontinence (bladder neck

practice due to its high incidence of related complications and stomal stenosis [4].

**3.1 Catheterizable channels: Mitrofanoff and Monti procedures** 

sparing the skin and decreasing the incidence of ammoniac dermatitis.

physical appearance; possible related complications, etc).

a. Previous surgical interventions:

closure or even access into the abdomen.

abdominal wall width challenge.

syndrome.

b. Obesity:

emptying [12,13].

In 1980, Paul Mitrofanoff made the first description on the use of a continent urinary catheterizable channel utilizing the appendix which was later popularized by Duckett et al. [3,12]. The Mitrofanoff principle consists in a urinary continent derivation brought to the skin anastomosed to a low pressure reservoir utilizing an anti reflux technique through which one can perform the CIC [13]. Ideally, the stoma should be easily accessible and aesthetically pleasant [13].

The rationale behind the Mitrofanoff procedure is the maintenance of a low pressure reservoir in which filling pressures do not exceed 20 cmH2O, while conduit pressure stands within 45-90 cmH2O and reaches up to 80-150 cmH2O under Valsalva maneuver [16].
