Operative note 38 Advanced
Mitrofanoff and Monti
What it does: a tube you catheterise through the tummy wall.
- Channel options: appendix (classic), or Monti. Monti = 4-5 cm bowel split lengthways in 3, re-rolled over a 12Ch catheter.
- Tunnel into the bladder, low and leaning down. Tunnel length = 3-4x tube width. That is the continence mechanism.
- Guard the ureteric orifices.
- Short, straight path to skin. Umbilicus or lower tummy. Rotation skin flap for the stoma.
- Stent catheter sewn in with fast-absorbing stitch. Balloon punctured so it can never be inflated and rip the channel.
- Flush every 6 h against mucus.
- Catheterise from ~6 weeks.
- Watch: Appendix already used for the ACE (constipation) channel? Plan a Monti on the other side.
From the UroRef Operative Quick Guide.