Dr. Sean Elliott, MD
Reconstructive Urologist
Mitrofanoff or Monti catheterizable channel
Mitrofanoff allows people to catheterize to empty their bladder.
One end of the Mitrofanoff is connected to the bladder and the other end to the abdominal wall, usually at the belly button (umbilicus). A valve is created where the Mitrofanoff enters the bladder to keep it from leaking urine out the belly button.
Because the catheter enters through the abdominal wall rather than the urethra, it is especially helpful for people who need to catheterize to empty their bladder but have trouble doing so through their urethra. Most commonly this is because people want to be able to catheterize while still in their wheelchair.
Kidneys
Ureters
Bladder
Figure 1.
Colon/large intestine
Small intestine
Appendix
Figure 2. Appendix is cut apart from the colon.
Colon/large intestine
Small intestine
Appendix
Figure 3. Tip of the appendix is removed. This makes it into a tube that is open at both ends.
A tunnel is created for the appendix. This tunnel in between the muscle and mucosa of the bladder serves a valve that prevents urine from leaking out the Mitrofanoff.
Exterior of Mucosa
Interior of Mucosa
Figure 4. An incision is made in the bladder muscle but not the mucosa, which is underneath.
Figure 5. The muscle is lifted off the mucosa exposing a “trough” of the exterior side of the mucosa (in gold). An opening is made in the mucosa at the lowest end of the trough (in pink).
Figure 6. The opening on the tip of the appendix is sewn to the hole in the mucosa.
Trough/tunnel is closed over the appendix. This creates a “flap valve”. When the bladder fills, the appendix gets squeezed between the mucosa and the muscle.
Outer muscular layer
Inner muscular layer
Appendix
Figure 7.
Figure 8. Cross sectional view of the appendix as it tunnels in the bladder wall. Empty bladder = open appendix.
Figure 9. Full bladder = closed appendix.
Figure 10. Mitrofanoff is connected to abdominal wall, usually at belly button.
Figure 10.
If the appendix is missing or is too short then we perform a “Monti” procedure.
The appendix is naturally the size of a catheter. The small intestine is too wide — a catheter would flop around inside it rather than going in a straight line. A Monti is reshaping the small intestines that it is the Size of a catheter.
Small intestine
Colon/large intestine
Small intestine
Colon/large intestine
2 cm
2 cm
Figure 11. There is no appendix. 2 cm of small intestine is removed.
Figure 13. The 2cm segment is opened lengthwise. The small intestine is typically 6 cm in circumference.
Small intestine
Colon/large intestine
2 cm
6 cm
Figure 14. The small intestine is unrolled. The inside (mucosa) is shown in pink. We now have a rectangle of intestine that is 2 x 6cm.
2 cm
6 cm
2 cm
Figure 12. The small intestine is reconnected by sewing.
Figure 15. The intestine is closed cross-wise around a 14F catheter.
Figure 16. This creates a tube that is 6cm its circumference is about the size of a 14f catheter.
Figure 17. The rest of the operation is performed as for a standard Mitrofanoff, including tunneling it into the bladder and bringing it out the belly button.
A tunnel is created for the Monti. This tunnel in between the muscle and mucosa of the bladder serves a valve that prevents urine from leaking out the Monti.
Exterior of Mucosa
Interior of Mucosa
Figure 18. An incision is made in the bladder muscle but not the mucosa, which is underneath.
Figure 19. The muscle is lifted off the mucosa exposing a “trough” of the exterior side of the mucosa (in gold). An opening is made in the mucosa at the lowest end of the trough (in pink).
Figure 20. The opening on the tip of the Monti is sewn to the hole in the mucosa.
Trough/tunnel is closed over the Monti. This creates a “flap valve”. When the bladder fills, the Monti is squeezed between the mucosa and the muscle.
Outer muscular layer
Inner muscular layer
Appendix
Figure 21.
Figure 22. Cross sectional view of the appendix as it tunnels in the bladder wall. Empty bladder = open Monti.
Figure 23. Full bladder = closed Monti.
Figure 24. Mitrofanoff is connected to abdominal wall, usually at belly button.
Figure 24.