Q. I read your answer to the woman who is a C5-6 quad that was experiencing serious problems with her indwelling Foley catheter and was considering a suprapubic procedure (“Suprapubic Revisited,” June 2010 Bladder Matters).
I am also a C5-6 female with an indwelling Foley. Although I’m not having any trouble the Foley, I would love to be able to ditch the tubing and leg bag. The suprapubic sounds better but also sounds like more tubing and a collection bag in another place.
I heard about a procedure called a Mitrofanoff in which you have a hole near your belly button like a suprapubic, but instead of an indwelling Foley and a bag, you do intermittent catheterization through the hole. It sounds good, but all the research I’ve turned up on the procedure applies only to kids.
How come there isn’t any info on this procedure for adults with SCI? Is it done in adults with SCI?
A. Janice, let’s start by explaining the surgery. A Mitrofanoff (pronounced me-TROFF-an-off) is a procedure in which a surgeon cuts a piece of tubular tissue — usually the appendix — and creates a conduit from a stoma (hole at or near the belly button) to the bladder. A person with a Mitrofanoff empties the bladder by passing an intermittent catheter through the stoma into the bladder — cathing with the same frequency as urethral intermittent catheterization.
In the right circumstances, a Mitrofanoff has advantages over a suprapubic because there is no indwelling Foley tube or no collection bag, and the stoma is visible and accessible, making it easier than trying to insert a catheter into the urethra. This enables a person with limited hand dexterity who can’t catheterize through the urethera to manage the bladder independently. Another advantage is, because the stoma is so easy to see and reach, cathing can be accomplished from the chair.
Charleene Frazier, RN, MS, an information specialist with Spinal Cord Central, says she has worked with several people who are happy with the Mitrofanoff. One of the success stories involves a C6 quad who had completed her master’s degree and built a career that required travel. After a successful Mitrofanoff, she was able to manage her bladder, travel and continue on her career path.
Frazier reports another person, a C4-5 quad, who had a successful Mitrofanoff and was able to catheterize with minimal assistance from her attendant, making her daily living easier and more convenient. It is important to note that in this person’s case, having an attendant who can assist with cathing on a regular basis is paramount.
As you have already discovered, most of the literature on Mitrofanoffs is associated with pediatric bladder management. Paula Wagner, a urol