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Thread: Was anyone told the mitrofanoff/augmentation could affect fertility?

  1. #1

    Was anyone told the mitrofanoff/augmentation could affect fertility?

    I was talking to a friend yesterday who is considering a Mitrofanoff from the same surgeon who did mine. However she's waiting until after she has kids because he told her it could make it harder for her to get pregnant!! THE DR. DID NOTTELL ME THIS! I would have remembered and WOULD NOT have had the mitrofanoff yet! If this is true and I was not informed and my fertility issues continue I AM GOING TO SUE HIS A**! He did say after surgery that he was considering using my fallopian tube for the Mitrofanoff but it was too short - good for him because if he had he would have been in soooo much trouble!

    So was anyone else told this?

  2. #2
    I am not aware of a Mitrofanoff procedure having an effect on fertility in women with SCI. I work mostly with men, but have had at least two female patients who have had the procedure and then went on to have successful pregnancies. The surgeon I work with uses the appendix (or if that's missing) a piece of small bowel. I've never heard of using fallopian tubes for this, but there's always a new way of doing things. Before you blow up, you should probably ask him for DETAILED information about the hows and whys he is aware of. Again, it hasn't been a problem for the women I have worked with.

    RAB

  3. #3
    Senior Member amanda's Avatar
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    akkkk. no, I was not told this. I'm not sure how it would change anything though. I did ask about pregnancy post mitro and my dr said I should be fine...never mentioned fertility issues.

    are you trying for another baby?!

    " The best way to predict the future is to invent it."
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  4. #4
    Senior Member Aly's Avatar
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    Asked my doc about pregnancy, because I was worried that with a growing belly that big if my appendix and bladder could stretch that far also. (May sound dumb but I had this image of my appendix tearing from my bladder) He had told me he knew of two specific women that had had successful pregnancies with C-sections with no complications. I'm assuming this also means no issues with fertility, but assumptions have gotten me in trouble before.

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  5. #5
    Emi,

    I don't think that Mitrofanoff would make it harder for a woman to become pregnant. The question is whether the conduit could be compromised during the pregnancy. I did a literature search on the subject and did not find much. One study by Roberts and Rafferty (2004) simply reported on doing a vaginal delivery in a patient with spina bifida and a Mitrofanoff procedure. Another study by Greenwell, et al. (2003) described two cases of "Mitrafanoff difficulties" out of 29 pregnant women who had a variety of surgeries that included surgical operations on the bladder and lower urinary tract. Clearly, there are some examples of women who have become pregnant even though they have Mitrofanoff procedures.

    There are many case reports of women who became pregnant even though they have the more drastic procedure of ureteral diversion to an ileal conduit. Gontero, et al. (2004) described lessons learned from two cases of urinary tract complications in pregnant women with ileal conduits, pointing out that an MRI urogram demonstrated compression of the ureter by the fetus and the need for antibiotic prophylaxis. Akerlund, et al. (1991) described the results of four pregnancies in women with urinary diversion through the continent ileal reservoir and pointed out the one patient showed urinary obstruction at the end of the pregnancy. Please note that the ureteral diversion to a ileal conduit is very different from a mitrofanoff. Here the ureters are diverted from the bladder to the ileal conduit and the bladder is not functional. Bravo & Katz (1983) described a case where they placed a tube to shunt the kindey during pregnancy. As far back as 1981, Greenberg, et al. declared that "ileal conduit is not a contraindication to pregnancy and subsequent normal spontaneous vaginal delivery." I also have a postdoctoral fellow in my laboratory who is quadriplegic with an ileal conduit and had two deliveries.

    The Mitrofanoff procedure should have even less risk of urinary obstruction than a ureteral diversion to an ileal conduit. The reason is that there is the option of restarting intermittent catheterization or even placing a foley catheter in those patients that shows signs of urinary obstruction. In my opinion, this just requires an obstetrician who is experienced, can monitor the situation, and knows what to do if there is obstruction.

    Last year, Hensle, et al. (2004) had a thoughtful article on the subject of urological and outcome of pregnancy in women after urinary tract reconstruction. Although none of these cases directly related to the Mitrofanoff procedure, what they said is relevant. They reviewed the obstetrics and urological history of 11 patients (12 pregnancies, 10 singletons and one twin) with previous urinary reconstruction delivered between 1989 and 2003. They said that all the patients had some difficult with clean intermittent catheterization during pregnancy and that four required continuous indwelling catheters, that 10 of the women had bladder infections and all received antibiotic suppression. They recommend antibiotic proophylaxis and that the patients may require indwelling catheters while pregnant.

    Wise.

    References

    Roberts NJ and Rafferty PG (2004). Vaginal delivery in a patient with spina bifida and a Mitrofanoff urinary diversion. J Obstet Gynaecol 24: 576. Department of Obstetrics and Gynaecology, Eastbourne District General Hospital, Eastbourne, UK. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15369947

    Greenwell TJ, Venn SN, Creighton S, Leaver RB and Woodhouse CR (2003). Pregnancy after lower urinary tract reconstruction for congenital abnormalities. BJU Int 92: 773-7. OBJECTIVE: To evaluate the effect of pregnancy on renal function, and the effect of congenital urinary tract abnormality and reconstruction on pregnancy and delivery. PATIENTS AND METHODS: The case notes were reviewed of 20 women (median age 32.5 years) who had had 29 live babies. Data collected included patient demographics, congenital urological abnormality, urological reconstructive procedure(s) and any subsequent urological complications. Pregnancy details, including urological and obstetric complications, presentation and mode of delivery, were obtained via a postal questionnaire from the relevant obstetrician. RESULTS: Seven patients had exstrophy-epispadias, seven spinal dysraphism, two sacral agenesis, and one each cerebral palsy, epispadias, imperforate anus and small bladder with vesico-ureteric reflux and congenital incontinence. They had had a mean (range) of 5.7 (1-12) urological reconstructive procedures each. Patients with exstrophy-epispadias had significantly more operations (mean 7.8) than those with spinal dysraphism (mean 4.14) or other diagnoses (mean 2.6) (P < 0.01). At the last follow-up 13 patients had an enterocystoplasty, six a neobladder and one an ileal conduit. Pregnancy-related urological complications were urinary tract infection in 15, upper tract obstruction requiring nephrostomy and stent in three, Mitrofanoff difficulties in two and pyelonephritis in one. There was no significant deterioration in glomerular filtration rate or serum creatinine after pregnancy. Only 10 of the births were normal or assisted vaginal deliveries. Seven patients had emergency and 12 had elective Caesarean sections for obstetric indications, including four breech births in the seven patients with vesical exstrophy. CONCLUSIONS: Pregnancy has no long-term effect on renal function and does not compromise reconstruction. Although there is a substantial complication rate and an increased need for Caesarean section, pregnancy in women with lower urinary tract reconstruction for congenital urological abnormalities is ultimately safe for both mother and baby. Interdisciplinary co-operation is desirable for a successful outcome. Institute of Urology, University College London, and Department of Gynaecology, University College London Hospital, London, UK. tamsin.greenwell@aol.com http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14616465


    Gontero P, Masood S, Sogni F, Fontana F, Mufti G and Frea B (2004). Upper urinary tract complications in pregnant women with an ileal conduit. Lessons learned from two cases. Scand J Urol Nephrol 38: 523-4. We describe the occurrence of severe upper urinary tract complications during pregnancy in two women with an ileal conduit. The first patient developed several episodes of left pyelonephritis throughout the duration of her pregnancy but never received proper antibiotic prophylaxis. Intravenous urography performed after delivery documented bilateral staghorn kidney stones and a non-functioning left kidney. The second patient developed severe left loin pain and a high temperature during the fourth month of pregnancy after discontinuing antibiotic prophylaxis. An MRI urogram demonstrated compression of the ureter by the foetus. Symptoms were relieved as soon as the antibiotic prophylaxis was resumed and the pain remained under control with the occasional use of paracetamol until delivery. Based on these observations it appears that the left upper urinary tract may be more prone to dilatation in pregnant patients with an ileal conduit and antibiotic prophylaxis is mandatory throughout the duration of the pregnancy in order to minimize the risk of severe upper urinary tract complications. Clinica Urologica, Universita del Piemonte Orientale, Novara, Italy. gontero@med.unipmn.it http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15841791

    Bravo RH and Katz M (1983). Ureteral obstruction in a pregnant patient with an ileal loop conduit. A case report. J Reprod Med 28: 427-9. A patient developed an obstruction of an ileal loop conduit during pregnancy. A left percutaneous nephrostomy was done under local anesthesia, and a tube was placed under sonographic guidance. The pregnancy was successful. http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=6684164

    Greenberg RE, Vaughan ED, Jr. and Pitts WR, Jr. (1981). Normal pregnancy and delivery after ileal conduit urinary diversion. J Urol 125: 172-3. Lower urinary tract diversion via an ileal conduit is not a contraindication to pregnancy and subsequent normal spontaneous vaginal delivery. This is true regardless of the etiology of underlying urologic dysfunction as long as maternal renal function and general health remain stable and obstetrical considerations of the underlying congenital abnormality of the patient do not preclude conception and delivery. http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=7206047

    Hensle TW, Bingham JB, Reiley EA, Cleary-Goldman JE, Malone FD and Robinson JN (2004). The urological care and outcome of pregnancy after urinary tract reconstruction. BJU Int 93: 588-90. OBJECTIVE: To assess the obstetric and urological outcomes during and after pregnancy following urinary tract reconstruction, as pregnancies after such surgery can have a significant effect on the function of the reconstructed urinary tract, and the reconstruction can significantly affect the delivery of the fetus. PATIENTS AND METHODS: We retrospectively reviewed the obstetric and urological history of 11 patients (12 pregnancies; 10 singletons and one twin) with previous urinary reconstruction, delivered between 1989 and 2003. Antepartum and postpartum urological function and obstetric outcomes were investigated. RESULTS: All the patients had some difficulty with clean intermittent catheterization (CIC) during pregnancy, and four needed continuous indwelling catheters. During pregnancy 10 women had several bladder infections and all received antibiotic suppression. There were eight Caesarean sections, two vaginal deliveries and one combined delivery. Six Caesareans were elective and three were emergent. The use of CIC returned to normal in all patients after delivery. CONCLUSIONS: Women with a urinary reconstruction can have successful pregnancies. The complexity of the surgery and the concern for possible emergency Caesarean section resulted in most patients having an elective Caesarean delivery before term. Antibiotic prophylaxis is recommended and patients may require indwelling dwelling catheters while pregnant but normal CIC can be resumed after delivery. Division of Paediatric Urology, Children's Hospital of New York, Presbyterian, NY, USA. TWHENSLEMD@aol.com http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15008736

    [This message was edited by Wise Young on 05-30-05 at 02:59 PM.]

  6. #6
    Thanks everyone, I dont see why it would affect fertility either...

  7. #7
    I am in the process of scheduling a similar surgery, but MY appendix aren't going to be used. One of my MAIN questions when I go back to the Mayo Clinic is children and how and if this will effect the bladder and pregnancy. The obvious things going through my mind is I would have to cath more because pregnant women pee a lot more, but I want to make double sure about everything else. It's a good question to ask.

    ~I now contain-with this new curiosity, with this flaming capacity to care once more, with reborn capacity to sing-I now contain the awful capacity to want and to love.~ Anne Rice

  8. #8
    Kristi, I just posted a topic on a procedure where the surgeon used part of the bladder wall to create the conduit. I met two women in Michigan who had it and they were very satisfied with the procedure. The appendix is usually the preferred conduit (unless it is too small) because it does not produce as much mucus as a piece of intestine (the ilium). Bladder mucosa does not produce mucus and therefore should have even less mucus. Also, such a conduit would go to the abdomen below the "bikini line" as opposed to a uretero-ileal diversion which generall is higher.

  9. #9
    Off-topic, but when discussing this all with my Uro he mentioned having the stoma placed higher, like the belly button could make a c-section more risky. I got mine way below the pantline.

    Aerodynamically, the bumble bee shouldn't be able to fly, but the bumble bee doesn't know that, so it goes on flying anyways--Mary Kay Ash

  10. #10

    Hello

    Hi I have a mitroffanoff, and I have had a healthy baby boy nearly 3 years ago now. BUT I was not told I would have to have a classical c-section due to not being able to deliver naturally. This put me and my baby at risk it took half an hour to get him out because of previous scar tissue and I lost 4 litres of blood. If I had known this I would have never ever had the mitroffanoff and I warn all women now because I am unable to have a sibling for my son due to all the complications and that breaks my heart.

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