Q.  I’ve been using a suprapubic catheter in my 18 years as a C4 quad, and it has worked fine — until recently. For the past year, I’ve been having a lot of pain from the Foley balloon rubbing against my bladder wall. I’ve tried having my attendant tape the SP tubing in different locations to stop the balloon from rubbing, but it hasn’t helped. I’ve also started having problems with the catheter getting plugged up with mucus — it seems like my attendant is having to constantly flush it out with saline to keep it draining.

I had a urological check-up, including ultrasound, X-rays and a cystoscopy to look inside my bladder. There are no stones or obstructions, but my bladder has shrunk quite a bit. My urologist suggested an ileovesicostomy as an option, and I have an appointment with a surgeon to discuss it further.

I’ve looked up the procedure on the web and am confused. There are explanations on the surgical part but no explanations on how it works. On forums, I see “ileovesicostomy” and “Mitrofanoff,” and they seem to be used interchangeably. Is there a difference?

What exactly is an ileovesicostomy and how does it work?

– Steve

A. Steve, I found the same thing: lots of information, but nothing that explains the basics of how an ileovesicostomy works, or the difference between a Mitrofanoff and ileovesicostomy. To clarify things, I turned to Paula Wagner, a urology nurse practitioner at U.C. Davis Medical Center in Sacramento, Calif. Wagner explains that some of the confusion is because both surgical procedures are considered “urinary diversions,” meaning they reroute urine flow from it’s normal pathway. A Mitrofanoff requires intermittent catheterization and an ileovesicostomy is free-flowing and requires a collection pouch.

To further clarify things, a Mitrofanoff is considered a “continent diversion.” A piece of tubular tissue — usually the appendix — creates a conduit from the bladder to a stoma (small hole), usually near the belly button. A person with a Mitrofanoff empties the bladder by passing an intermittent catheter through the stoma into the bladder and must catheterize with the same frequency as urethral intermittent catheterization. For further information the Mitrofanoff procedure, see the August 2010 Bladder Matters.

Wagner explains that an ileovesicostomy — pronounced il-eo-ves-i-kos’tah-me — takes part of the ileum (small intestine) and attaches one end to the bladder wall and routes the other end to create a stoma on the lower right side of the abdomen to create a “free-flowing diversion.” She says that a surgeon will usually start people that are unable to pe