ABSTRACT
An 8-year-old female with a low lumbar myelomeningocele and paraplegia presents to your clinic for assistance with bowel management because of her daily soiling. Her pertinent past surgical history includes a ventricular peritoneal shunt, vesicostomy that was closed at age 5 years at which point she underwent an appendicovesicostomy (Mitrofanoff), bladder augmentation, and cecostomy. No bladder neck tightening or closure was performed. Within a few months of placement of the Mitrofanoff, the stoma closed at the skin level and was no longer accessible. She is leaking urine constantly from her urethra. Her mother has attempted clean intermittent catheterization every 3 hours in an effort to keep her dry, but this was not successful.
