Mitrofanoff Procedure: How It Works, Recovery, Risks and Life After Surgery
Updated: 6 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review
Quick Answer: What is a Mitrofanoff procedure?
A Mitrofanoff procedure is a bladder surgery that uses the appendix to build a small channel from the bladder to an opening (stoma) on the belly. A person empties the bladder by passing a thin catheter through the stoma every three to four hours. It helps children and adults with certain bladder conditions stay dry without a urine bag. [1]
What the research says
Appendix channels hold up well over the long term. In a study of 510 children, the risk of needing a deeper channel repair (subfascial revision) 10 years after surgery was 8.6% for appendix channels, compared with 15.5% for channels built from intestine (Monti) and 32.3% for spiral Monti channels placed at the belly button. (Szymanski et al., Journal of Pediatric Urology, 2015) [2]
About 1 in 5 people have a channel complication. A meta-analysis of 565 patients found a complication rate of 20.4% when the whole appendix formed the channel and 29.2% when the appendix was split to make two channels; the difference was not statistically significant. (Chua et al., World Journal of Urology, 2025) [3]
Robotic surgery may shorten the hospital stay. Across 6 studies of 270 children, robot-assisted surgery led to less blood loss and a shorter hospital stay than open surgery, with similar rates of channel narrowing, leakage, wound infection and repeat surgery. (Liu et al., Pediatric Surgery International, 2026) [4]
Key takeaways
A Mitrofanoff turns the appendix into a narrow tunnel that links the bladder to a small, self-sealing opening on the belly. [1]
The bladder is emptied with a catheter through the stoma about every three to four hours and at least once at night. [1]
Children with spina bifida, cerebral palsy or bladder birth defects, and adults with nerve damage, cancer or severe incontinence may benefit. [1]
Expect up to a week in hospital and self-catheterization training at about six weeks. [1]
Roughly 2 in 10 people need a revision surgery years later, most often for narrowing of the channel. [1]
What is a Mitrofanoff procedure?
A Mitrofanoff procedure (pronounced "me-TROF-an-off") is a surgery that creates a new route for urine to leave the bladder through an opening in the belly. Surgeons use the appendix to make a channel that connects the bladder to a small opening called a stoma. [1]
To empty the bladder, you pass a flexible tube (catheter) through the stoma and into the bladder. No bag is worn on the outside of the body. [1]
Professor Paul Mitrofanoff developed the procedure in 1976. Doctors also call it an appendicovesicostomy or a continent urinary diversion. [1]
If a person no longer has an appendix, the surgeon can build the channel from a short piece of small intestine instead. This version is called a Monti or Monti-Yang channel, after the surgeons who first described it. [1]
Mitrofanoff at a glance
Feature | Details |
Other names | Appendicovesicostomy, continent urinary diversion [1] |
Tissue used | Appendix (or small intestine if there is no appendix) [1] |
Surgeon | Urologist [1] |
Anesthesia | General (you are asleep) [1] |
Hospital stay | Up to about one week [1] |
How urine leaves | Catheter through a stoma on the belly [1] |
How often to empty | Every 3–4 hours and at least once at night [1] |
External bag needed | No [1] |
How does a Mitrofanoff procedure work?
A Mitrofanoff works by giving the bladder a second, controllable exit that you open only when you insert a catheter. The kidneys make urine, which travels down two thin tubes (ureters) into the bladder, where it is stored. Normally, urine leaves through the urethra. [1]
With a Mitrofanoff, the appendix is detached from the large intestine and reused as a tunnel. One end is joined to the bladder and the other to the stoma on the belly. The surgeon builds a valve where the appendix meets the bladder. This valve squeezes shut as the bladder fills, which helps prevent leaks. [1]
You can live a long, healthy life without an appendix, which is why it can be reused this way. Many people have it removed when they develop appendicitis. [1]
Who needs a Mitrofanoff procedure?
A Mitrofanoff procedure is for children and adults who cannot empty or control their bladder well and who find catheterizing through the urethra difficult. Many have a neurogenic bladder, meaning nerve problems stop the bladder muscle from working normally. [1]
Children | Adults |
Birth defects affecting the nervous system that cause neurogenic bladder [1] | Bladder, prostate or colorectal cancer [1] |
Bladder exstrophy or cloacal exstrophy (the bladder forms inside out and exposed) [1] | Severe urinary incontinence and other bladder control problems [1] |
Sacral agenesis (part of the lower spine is missing) [1] | Multiple sclerosis or Parkinson's disease [1] |
Spina bifida [1] | Spinal cord injury, paralysis or spine tumors [1] |
Spinal cord injury [1] | Stroke [1] |
How do you prepare for a Mitrofanoff procedure?
Preparing for a Mitrofanoff procedure mainly means emptying the intestines as much as possible to lower the risk of infection. Your care team will give you exact instructions, which may include: [1]
Fasting: drinking only clear liquids before surgery.
Bowel cleanse: taking a preparation that clears the intestines.
What happens during a Mitrofanoff procedure?
During a Mitrofanoff procedure, a urologist removes the appendix from the intestine and reconnects it between the bladder and the belly wall while you are under general anesthesia. The main steps are: [1]
Incision: the surgeon opens the abdomen.
Appendix release: the appendix is detached from the large intestine.
Channel creation: one end of the appendix is joined to a small cut in the bladder, and the other end to a smaller opening in the belly (the stoma).
Valve: a valve is made where the appendix meets the bladder to help stop leaks as the bladder fills.
Temporary drain: a tube called a suprapubic catheter is placed through a small cut below the stoma straight into the bladder. It drains urine into a bag while the bladder heals.
Ureteral stents (if needed): small tubes may be placed in the ureters so urine flows freely from the kidneys to the bladder. Not everyone needs them.
Closure: the main incision is closed with stitches that dissolve as the bladder heals.
If your appendix is missing or unsuitable, the same steps are used with a short tube of small intestine. [1] For a wider look at these surgeries, see our guide to urinary reconstruction and diversion.
What is recovery like after a Mitrofanoff procedure?
Recovery after a Mitrofanoff procedure usually starts with up to a week in hospital, followed by several weeks of healing with tubes in place before you begin self-catheterization. [1]
In the hospital
IV fluids: you may receive fluids through a vein, with no solid food, for a couple of days so the intestines can heal. [1]
Bed rest: you may need to lie flat for a day or two. Rolling side to side and moving your legs is fine, but sitting up is not. [1]
Channel catheter: a catheter sits inside the new channel to keep it from closing. [1]
Recovery timeline
Time after surgery | What usually happens |
First 1–2 days | IV fluids, no solid food; lie flat in bed [1] |
Up to 1 week | Hospital stay; go home with the channel catheter and suprapubic tube [1] |
First few weeks | Blood in the urine and painful bladder spasms are common [1] |
Up to 4 weeks | Catheter stays in the channel to keep it open [1] |
About 6 weeks | Clinic visit to learn self-catheterization; tubes removed in the office, no extra surgery needed [1] |
6–8 weeks | Short procedure to remove ureteral stents, if they were placed [1] |
Every year | Blood tests, bladder and kidney imaging, and other check-ups [1] |
For the first few weeks, blood in the urine (hematuria) and painful bladder spasms are expected. Your doctor may prescribe pain relievers and medicines that relax the bladder muscle to ease the spasms. [1]
How do you use a Mitrofanoff for self-catheterization?
Using a Mitrofanoff means emptying your bladder with a catheter through the stoma at regular times through the day and night. Even young children can learn to do it on their own. [1] The routine has three steps: [1]
Insert: pass the catheter through the stoma and along the channel into the bladder.
Drain: let urine flow through the catheter into a toilet or collection container.
Remove: take the catheter out once the bladder is empty. The stoma closes on its own.
How often should you empty your bladder?
Most people empty the bladder through the Mitrofanoff every three to four hours and at least once during the night. Emptying on schedule helps prevent leaks. [1]
Urine can still pass through the urethra after a Mitrofanoff, but you should not try to urinate that way. [1]
Why does the channel need flushing?
The appendix keeps making mucus even in its new role, so the channel needs regular flushing (irrigation). Your care team will show you how. Flushing can affect the salt and mineral balance (electrolytes) in your blood, so regular blood tests are used to check it. [1]
For general tips on catheter hygiene and supplies, read our guide to urinary catheterization and essential care.
What are the benefits of a Mitrofanoff procedure?
The main benefit of a Mitrofanoff procedure is better bladder control with fewer leaks and easier catheterization. [1]
Less leakage: the valve and regular emptying lower the risk of urinary incontinence. [1]
Easier access: many people find a catheter goes in more easily and comfortably through the belly than through the urethra. [1]
Independence: even young children can catheterize themselves. [1]
No external bag: urine stays in the bladder until you choose to empty it. [1]
What are the risks of a Mitrofanoff procedure?
The most common long-term risk of a Mitrofanoff procedure is narrowing or wear of the channel, which leads about 2 in 10 people to need a revision surgery years later. [1] Reviews of the procedure report that up to 8% of people need an early repeat operation for problems such as bleeding, bowel blockage or a leak, and overall repeat-surgery rates reach up to 32% in modern series. [5]
In a large international study of 675 young patients, the risk of a repair at the stoma was 9.3–12.0% at five years. [6]
Risk | What it means |
Channel narrowing (stenosis) | The tunnel or stoma tightens, making the catheter hard to pass; may need revision [1] |
Stoma leakage | The stoma stops sealing between catheterizations; revision can fix it [1] |
Mucus build-up | The appendix keeps making mucus, so regular flushing is needed [1] |
Electrolyte imbalance | Flushing can shift blood minerals; checked with blood tests [1] |
Bladder stones | Hard mineral deposits can form in the bladder [1] |
Infection | Includes chronic urinary tract infections [1] |
Bleeding | A risk of any bladder surgery [1] |
Bowel obstruction | A blockage in the large intestine [1] |
Bladder cancer | Listed among the risks of bladder surgery [1] |
What is life like with a Mitrofanoff?
Most people with a Mitrofanoff live long, healthy and active lives. You can exercise and even swim, though you may need to avoid some contact sports. With the right medical care, women with a Mitrofanoff can have healthy pregnancies. [1]
Your doctor will check your urinary system every year. Typical tests include: [1]
Blood tests: electrolytes, kidney function and liver function.
Cystoscopy: a thin camera to look inside the bladder.
Ultrasound: of the kidneys and pelvis.
X-rays: of the kidneys, ureters and bladder.
How is a Mitrofanoff different from a urostomy?
A Mitrofanoff stores urine in the bladder until you drain it with a catheter, while a urostomy usually drains urine continuously into a bag. Both let urine leave through an opening in the belly. [1]
Feature | Mitrofanoff | Urostomy |
Uses the bladder | Yes [1] | Bypasses the bladder or uses a bowel reservoir [1] |
External bag | No [1] | Often worn at all times, depending on type [1] |
Control over urine flow | Yes, you choose when to empty [1] | Often no control [1] |
Catheter needed | Yes [1] | Usually no, though some types use a pouch emptied by catheter [1] |
Some people find a urostomy more convenient because no catheter is needed. [1] Learn more in our guide to bladder reconstruction surgery.
Is a Mitrofanoff procedure permanent?
A Mitrofanoff procedure can be reversed by removing the channel. Because the body does not need the appendix, the surgeon removes it rather than reattaching it. [1] After removal, the bladder may be emptied by: [1]
Urinating through the urethra, or leaking and wearing pads or diapers.
Passing a catheter through the urethra into the bladder.
Having a urostomy.
When should you call a doctor after a Mitrofanoff procedure?
You should call your doctor after a Mitrofanoff procedure if you cannot empty your bladder or notice signs of infection or bleeding. Contact your care team if you have: [1]
Trouble emptying your bladder or passing the catheter.
Heavy bleeding, swelling or bruising.
Nausea and vomiting.
Severe pain.
Signs of infection, such as fever or foul-smelling discharge.
Conclusion
A Mitrofanoff procedure gives people with difficult bladder conditions a reliable, bag-free way to empty the bladder. By turning the appendix into a small channel with a built-in valve, it lets children and adults catheterize through the belly, stay drier and live active lives. [1]
Success depends on a steady routine: emptying every three to four hours, flushing the channel, and keeping up with yearly check-ups. Long-term studies show appendix channels hold up well, though some people will need a repair later on. [2] [5]
Next step: If you or your child live with a bladder that does not empty properly, ask a urologist whether a Mitrofanoff is an option. To understand the condition behind most Mitrofanoff surgeries, read our guide to neurogenic bladder, and explore our urinary catheterization guide for practical catheter care.
FAQ
What is a Mitrofanoff procedure?
A Mitrofanoff procedure is a surgery that uses the appendix to create a channel between the bladder and a small opening (stoma) on the belly. Urine is drained by passing a catheter through the stoma, so no external bag is needed. [1]
Who needs a Mitrofanoff procedure?
A Mitrofanoff procedure is used for children and adults who cannot empty their bladder well, often because of a neurogenic bladder. Common causes include spina bifida, cerebral palsy, spinal cord injury, bladder exstrophy, multiple sclerosis and some cancers. [1]
How long is the hospital stay after a Mitrofanoff?
The hospital stay after a Mitrofanoff is up to about one week. You go home with a catheter in the new channel and a suprapubic tube, and both are removed in the clinic when self-catheterization begins. [1]
How often do you catheterize with a Mitrofanoff?
Most people catheterize through the Mitrofanoff every three to four hours and at least once at night. Regular emptying helps prevent leakage. [1]
Can you still pee normally with a Mitrofanoff?
Urine can still come out of the urethra after a Mitrofanoff, but you should not try to urinate that way. The bladder should be emptied through the stoma on schedule. [1]
What are the most common Mitrofanoff complications?
The most common Mitrofanoff complication is narrowing (stenosis) or wear of the channel, which leads about 2 in 10 people to need a revision surgery years later. Other risks include stoma leakage, infection, bladder stones and electrolyte changes from channel flushing. [1]
Can you swim or get pregnant with a Mitrofanoff?
Swimming and most exercise are possible with a Mitrofanoff, although some contact sports may need to be avoided. With the right medical care, women with a Mitrofanoff can have healthy pregnancies. [1]
Is a Mitrofanoff reversible?
A Mitrofanoff is reversible: a surgeon can remove the channel and the appendix. Afterward, the bladder is emptied through the urethra, by urethral catheter, or with a urostomy. [1]
What should I do if I cannot pass the catheter into my Mitrofanoff?
Do not force the catheter. Relax, reposition and try again with plenty of lubricant. If you still cannot empty your bladder within a few hours, seek urgent care, because an overfull bladder can be dangerous.
Is it normal for a Mitrofanoff stoma to leak?
A Mitrofanoff channel is designed so urine does not leak from the stoma. Tell your care team if you notice leaking, because the channel may need to be checked or adjusted.
Related Reading
Clean Intermittent Catheterization (CIC) explains how to empty the bladder safely with intermittent catheterization.
Augmentation Cystoplasty: Bladder Augmentation Surgery explains bladder augmentation surgery, often done with a Mitrofanoff.
Neurogenic Bladder: Causes, Symptoms, and Management covers neurogenic bladder causes, symptoms and management.
Appendicostomy (MACE Procedure): Overview, Process, and Recovery describes the MACE procedure, a similar channel for bowel washouts.
References
Cleveland Clinic. Mitrofanoff Procedure: Purpose, Process & Recovery. Cleveland Clinic. Last updated July 18, 2022. https://my.clevelandclinic.org/health/treatments/23535-mitrofanoff-procedure
Szymanski KM, Whittam B, Misseri R, et al. Long-term outcomes of catheterizable continent urinary channels: What do you use, where you put it, and does it matter? J Pediatr Urol. 2015;11(4):210.e1-210.e7. PMID 26071074. https://doi.org/10.1016/j.jpurol.2015.05.002
Chua ME, Rivera K, Romao R, et al. Mitrofanoff complications: time-to-event analysis of split versus intact appendix and meta-analysis. World J Urol. 2025;43(1):90. PMID 39870851. https://doi.org/10.1007/s00345-024-05434-y
Liu Y, Xu Z, Feng S, et al. Comparative outcomes of robot-assisted and open appendicovesicostomy in children: a systematic review and meta-analysis. Pediatr Surg Int. 2026;42(1):362. PMID 42645597. https://doi.org/10.1007/s00383-026-06601-5
Veeratterapillay R, Morton H, Thorpe AC, et al. Reconstructing the lower urinary tract: The Mitrofanoff principle. Indian J Urol. 2013;29(4):316-321. PMID 24235794. https://doi.org/10.4103/0970-1591.120113
Szymanski KM, Lopez PJ, Corbetta JP, et al. Do anterior catheterizable urinary channels have fewer complications than posterior channels? An international cohort study. J Pediatr Urol. 2018;14(1):48.e1-48.e7. PMID 28822627. https://doi.org/10.1016/j.jpurol.2017.06.020
Medical disclaimer
This article is for general education and does not replace advice from your doctor or urologist. Decisions about bladder surgery, catheterization and aftercare should be made with a qualified healthcare professional who knows your medical history. If you have severe pain, fever, heavy bleeding or cannot empty your bladder, seek medical care right away.
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