The Mitrofanoff principle or appendicovesicostomy is a surgical procedure that creates a tube connecting the bladder with a stoma usually located in the belly button down which a catheter can be passed. The tube can be fashioned from appendix, ileum or ureter.

Often performed in conjunction with bladder augmentation.

The procedure was developed by Dr. Paul Mitrofanoff, and first used in 1980. The Mitrofanoff principle contains five elements:

  • A small conduit is brought to the skin to produce a stoma through which patients can catheterise themselves.
  • A connection called a flap valve is surgically produced between the the bladder and the implanted tube that prevents urine from pouring out.
  • A low-pressure reservoir with enough storage room to grant patients a socially acceptable time between catheterisations. If the bladder is not naturally large enough, an enlarged bladder, or a whole new bladder is created using bowel or stomach segments.
  • In order to protect the kidneys from high-pressured urine reflux, from the bladder up through the ureters, the ureters are reattached to the bladder using an anti-reflux valve technique.
  • The bladder is maintained and completely emptied by means of regular, reliable clean intermittent catheterisations by the patient or caregiver.

Snyder, H.M. (1987). Principles of pediatric urinary tract reconstruction – a synthesis. In : Gillenwater, J.Y., Grayhack, J.T., Howards, S.S. and Duckett, J.W. (eds). Adult and pediatric urology.(2): 1726-1781.