Name of the Procedure:

Cutaneous Appendico-Vesicostomy (CAV), also known as the Mitrofanoff procedure

Summary

The cutaneous appendico-vesicostomy is a surgical procedure where a conduit is created between the bladder and the skin using the appendix. This allows for catheterization through the abdominal wall, enabling bladder drainage.

Purpose

Medical Condition/Problem: Incontinence, neurogenic bladder, bladder exstrophy, or other conditions affecting the normal urinary function. Goals: To create a reliable and easily accessible route for catheterization, improving urinary control and preventing kidney damage.

Indications

• Chronic urinary retention
• Recurrent urinary tract infections (UTIs)
• Difficulty with traditional catheterization methods
• Patients with conditions such as spina bifida, spinal cord injuries, or bladder exstrophy that affect bladder function.

Preparation

• Fasting for at least 8 hours before surgery.
• Adjusting or stopping certain medications as advised by the healthcare provider.
• Preoperative assessments including blood tests, urine tests, and imaging studies (e.g., ultrasound, MRI).

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made in the abdomen.
3. The appendix is identified and detached from its normal position.
4. One end of the appendix is attached to the bladder, creating a new passage.
5. The other end is brought out through the abdominal wall to the skin, forming a stoma.
6. The stoma is fitted with a catheterizable channel to facilitate bladder emptying.
7. The incisions are closed with sutures or staples.

Tools/Technology: Surgical instruments, laparoscopic equipment, sutures/staples. Anesthesia: General anesthesia is administered.

Duration

The procedure typically takes 2 to 4 hours.

Setting

Performed in a hospital operating room.

Personnel

• Surgeon (usually a urologist or pediatric urologist)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks: Infection, bleeding, pain at the surgical site.
• Rare complications: Stomal stenosis, leakage at the surgical site, bowel obstruction, injury to surrounding organs.

Benefits

• Improved bladder control
• Reduction in urinary tract infections
• Enhanced quality of life
• Potential normalization of kidney function Benefits might be realized within weeks to months post-surgery, depending on individual recovery rates.

Recovery

• Hospital stay for 3 to 7 days post-surgery.
• Pain management with prescribed medications.
• Instruction on stoma care and catheterization techniques.
• Follow-up appointments for stoma and bladder evaluation.
• Avoid heavy lifting and strenuous activity for several weeks.

Alternatives

• Indwelling urinary catheter
• Intermittent self-catheterization through the urethra
• Suprapubic catheter
• Pros: Alternatives may be less invasive.
• Cons: Alternatives might not offer the same level of control, comfort, or quality of life improvement.

Patient Experience

• During the procedure: The patient is under general anesthesia and will not feel pain.
• After the procedure: Postoperative pain managed with medication. Initial discomfort around the stoma and surgical site.
• Long-term: Learning and adapting to catheterization through the new stoma, with supportive care available for any concerns or complications.

Pain management and comfort measures, like proper catheterization techniques and stoma care, will be taught to ensure ease and compliance with the new routine.