mitrofanoff vs ileovesicostomy

crppled007 · 03-14-2010, 01:15 PM

I've had a SP tube for about 21 yrs, I'm a c4, and the past few times I've changed it, every 4 weeks, I've gotten really bad bladder cramps along with AD. Never really had that problem, only very rarely.

I went to a Neuro-Urologist and he suggested an Ileovesicostomy. (he was a real pr$ck, no bedside manner, not personable at all. I'm going to a different one) I've read every post here regarding the Ileo and mitronanoff. From what I gathered the mitro requires cathing. I really love the freedom of the SP allowing hooking up my legbag and nightbag, and going on about my day.

Are the both the same, what procedure allows the freedom of the SP but without having a foreign body inside me?
cripp

SCI-Nurse · 03-15-2010, 09:09 AM

How complete is your C4 injury? Usually this would mean you do not have the hand or arm function to cath yourself through a Mitrofanoff or other abdominal stoma. This would mean you would have to have someone always available to cath you every 4 hours or so (and more often immediately after this surgery). This would need to be a combination of a Mitrofanoff and an augmentation (a big surgery) or the ileovesicostomy (using ilium or small bowel to construct a neobladder). You would not be able to use your native bladder alone most likely as it is likely your bladder is tiny and shrunken after using an indwelling catheter for so long.

You can still get AD from allowing your bladder to get too full, and would most likely need to take anticholenergic medications still. I assume you are already taking them to try to manage your bladder spasms?? Do you use a numbing agent like lidocaine gel when changing your SP now?

If you are considering a surgical procedure, there is also the possibility of an ileo-conduit which would take your bladder out of the picture all together, and then drain your urine through an "incontinent" urinary ostomy. This would mean wearing a urinary ostomy appliance all the time, and draining into this and a bag 24/7.

No matter what you choose it would be wise to get at least a second opinion if not a third.

(KLD)

crppled007 · 03-16-2010, 09:26 AM

Quote:

Originally Posted by SCI-Nurse

How complete is your C4 injury?

I'm an incomplete having feeling and movement all over, but not enough to be functional. I can drive my chair but that's about it.

Quote:

Usually this would mean you do not have the hand or arm function to cath yourself through a Mitrofanoff or other abdominal stoma. This would mean you would have to have someone always available to cath you every 4 hours or so (and more often immediately after this surgery). This would need to be a combination of a Mitrofanoff and an augmentation (a big surgery)

Couldn't do that, the whole reason I got SP tube was I hated being cathed. It's such a hasle for me and my caregivers.

Quote:

or the ileovesicostomy (using ilium or small bowel to construct a neobladder). You would not be able to use your native bladder alone most likely as it is likely your bladder is tiny and shrunken after using an indwelling catheter for so long.

That's what I was looking into, any links on what that intails? Everything on CareCure refers back to the mitronanoff.

[uote]You can still get AD from allowing your bladder to get too full, and would most likely need to take anticholenergic medications still. I assume you are already taking them to try to manage your bladder spasms?? Do you use a numbing agent like lidocaine gel when changing your SP now?[/quote]

I was taking ditropan just whenever I would have bladders cramps, but now just start the 10mg XL everday. No I don't use any lidocane, I'm going to the next time I change
it. Do I put it on the tube itself, or around the hole?

Quote:

If you are considering a surgical procedure, there is also the possibility of an ileo-conduit which would take your bladder out of the picture all together, and then drain your urine through an "incontinent" urinary ostomy. This would mean wearing a urinary ostomy appliance all the time, and draining into this and a bag 24/7.

That's the idea he was suggesting, I'm going to another Dr next week, he's at Baylor (which is the best hospital for SCI here in TX) which he did the full workup on my urinary tract, bladder scope (OUCH

) I like the idea of not having to cath, I don't mind another bag as long as it gives me more freedom

SCI-Nurse · 03-16-2010, 09:34 AM

You should be taking an anticholenergic full time, not prn. It doesn't work that way.

When changing your SP tube, get a Urojet for the lidocaine. Put some on the catheter (using sterile technique) and then squirt some thorough the SP tract (stoma) to lube it up good before inserting the new catheter.

Both an augmentation and a ileo-conduit are BIG surgeries. Augmentations are rarely done except for those who plan to do intermittent cath.

(KLD)

03-14-2010, 01:15 PM	#1
crppled007 Senior Member Join Date: May 2004 Location: Serenity Posts: 458	mitrofanoff vs ileovesicostomy I've had a SP tube for about 21 yrs, I'm a c4, and the past few times I've changed it, every 4 weeks, I've gotten really bad bladder cramps along with AD. Never really had that problem, only very rarely. I went to a Neuro-Urologist and he suggested an Ileovesicostomy. (he was a real pr$ck, no bedside manner, not personable at all. I'm going to a different one) I've read every post here regarding the Ileo and mitronanoff. From what I gathered the mitro requires cathing. I really love the freedom of the SP allowing hooking up my legbag and nightbag, and going on about my day. Are the both the same, what procedure allows the freedom of the SP but without having a foreign body inside me? cripp __________________ C4 incomplete since 1985

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03-15-2010, 09:09 AM	#2
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,361	How complete is your C4 injury? Usually this would mean you do not have the hand or arm function to cath yourself through a Mitrofanoff or other abdominal stoma. This would mean you would have to have someone always available to cath you every 4 hours or so (and more often immediately after this surgery). This would need to be a combination of a Mitrofanoff and an augmentation (a big surgery) or the ileovesicostomy (using ilium or small bowel to construct a neobladder). You would not be able to use your native bladder alone most likely as it is likely your bladder is tiny and shrunken after using an indwelling catheter for so long. You can still get AD from allowing your bladder to get too full, and would most likely need to take anticholenergic medications still. I assume you are already taking them to try to manage your bladder spasms?? Do you use a numbing agent like lidocaine gel when changing your SP now? If you are considering a surgical procedure, there is also the possibility of an ileo-conduit which would take your bladder out of the picture all together, and then drain your urine through an "incontinent" urinary ostomy. This would mean wearing a urinary ostomy appliance all the time, and draining into this and a bag 24/7. No matter what you choose it would be wise to get at least a second opinion if not a third. (KLD)

03-16-2010, 09:34 AM	#4
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,361	You should be taking an anticholenergic full time, not prn. It doesn't work that way. When changing your SP tube, get a Urojet for the lidocaine. Put some on the catheter (using sterile technique) and then squirt some thorough the SP tract (stoma) to lube it up good before inserting the new catheter. Both an augmentation and a ileo-conduit are BIG surgeries. Augmentations are rarely done except for those who plan to do intermittent cath. (KLD)