Mitrofanoff, Malone and Bladder Augmentation Surgery

The Mitrofanoff or Monti channel is created so that urine can drain out from the bladder when a catheter (small tube) is passed into the channel.

• A Mitrofanoff is a surgery where the appendix is used to create a channel. A channel is like a
  tunnel from the skin to the bladder.
• A Monti is a surgery that uses a piece of your child’s small bowel if their appendix cannot be used to create the channel. A Monti works in the same way as a Mitrofanoff.

When the catheter is removed, the channel valve (door) closes, and no urine will leak from the Mitrofanoff or Monti.

The Malone or Neo-Malone channel is created so that stool (poop) can be flushed out of the colon (or bowel). This happens when a catheter (small tube) is passed into the channel and a solution of water mixed with other ingredients is flushed into the catheter.

• A Malone Appendicostomy is a surgery where the appendix is used to create a channel. This
  channel is like a tunnel from the colon to the skin.
• The Neo- Malone is a surgery that uses a piece of bowel to create the channel, if the child does
  not have an appendix, or if the appendix was used for the Mitrofanoff.
• The Neo-Malone works the same way as a Malone.

When the catheter is removed, the channel valve (door) closes, and no stool (poop) will leak out of the Malone or Neo-Malone.

The Bladder Augment is designed to make the bladder bigger which will allow the bladder to hold more urine and improve the pressure in the bladder. This may help the child stop having urinary accidents or wetting.

• A Bladder Augment creates a larger bladder.
• This larger bladder is created by taking a piece of the bowel and attaching it to the bladder.

Your child will be admitted to the hospital the day before their surgery. The Colorectal Team will give your child a “bowel prep.” A “bowel prep” will help clean-out your child’s colon (bowel) before the surgery.

The Colorectal and Urology surgeons will work together during the surgery. The surgery takes about 4-8 hours, and you will get updates from the operating room staff throughout the surgery. After surgery, your child will stay in the hospital for 1-2 weeks. They will have several tubes in their body following the surgery. Some tubes will stay in place after your child leaves the hospital, while some will be removed before they go home.

• Two (2) tubes will be removed BEFORE your child goes home:
  • A Nasogastric tube (NGT) placed in your child’s nose will keep their stomach and bowels empty.
  • A Foley Urethral Catheter (tube) placed in your child’s urethra will drain urine.
• Three (3) tubes will stay in place when your child goes home to protect their new channels and to protect the bladder while the channels heal.
  • A suprapubic tube (SP) – the SP tube keeps urine draining from the bladder. We think of it as a “safety tube” while the Mitrofanoff or Monti channel is healing.
  • A Mitrofanoff tube
  • A Malone tube

When a Mitrofanoff and Malone are created at the same time, the child will have two channels or tunnels.

• Each channel will have an opening on the abdomen (or belly area).
• One channel will open from the belly button, and one will open from the lower right side of
  the belly.

There will be a surgical scar in the middle of your child’s belly. There will also be a small scar where the SP tube was.

Your child is having major surgery and there are some risks that might include:

• Slow moving bowels after surgery (this is called an ileus)
• The need for a blood transfusion
• An infection requiring antibiotics
• Urine leaking after the bladder augmentation. This would cause the tubes to stay in place longer.
• Accidental tube removal requiring replacement