Yang-Monti's Catheterizable Stoma in Children

Abstract

Background: In 1981, Mitrofanoff described a procedure to create a continent urinary stoma for clean intermittent catheterization. Since then several procedures have been described including Yang-Monti ileovesicostomy for effective catheterization.

Objectives: We report on our experience from the use of Monti's procedure in children at our center.

Patients and methods: Children < 18 years of age undergoing urinary diversion/reconstruction with Yang-Monti's procedure for congenital conditions or neuropathic bladder formed the study group. All these children, post-operatively were taught clean intermittent catheterization (CIC) and put on a regime using a 14/16 Fr catheter every 3 hours. The children were followed regularly at 3, 6, 12, 18 and 24months post-operatively, with special attention paid to any problems with catheterization and incontinence.

Results: During the period from Jan 2000 to Dec 2011, at our center, 19 children less than eighteen years of age underwent urinary diversion with Yang-Monti's catheterizable stoma. The indications for urinary diversion was neuropathic bladder in eight, exstrophy bladder in seven , valve bladder syndrome in three and persistent urethral stricture in one. None of the children found CIC difficult during the post-operative period and there was no hindrance to the passage of the catheter.

Conclusions: Although the appendix remains the tissue of choice for creation of catherterizable stoma, the Yang-Monti ileovesicostomy is effective, convenient conduit for children. Long-term complications are minimal and children find this comfortable to do CIC.

Keywords: Catheterization; Ileum; Surgical Stomas; Urinary Bladder; Urinary Diversion.

Figure 1.. Isolation of 2.5 cm Ileal Segment

Figure 2.. Creation of Yang-Monti’s Tube

Figure 3.. Anastomosis of Yang-Monti’s Tube to the Postero Lateral Aspect of the Augmented Bladder

Figure 4.. Diagrammatic Representation of Construction of Ileal Tube

A. 3.5 cm ileal segment is isolated on its mesentery. B. segment is divided in half for an 80% of circumference, leaving strip of bowel intact over mesentery, resulting 2 strips of ileum are incised and opened on opposite sides, leaving strip intact over the mesentery. C. incised rings are unfolded in opposite directions, unfolded bowel is straightened and reconfigured by sewing corners along the mesentery to main strip. D. long strip of bowel is rolled into a tube over a catheter; the resulting tube is 12 to 14 cm long and accepts a 10F catheter. Mesentery is in the center. Either end may be extensively spatulated or shortened as needed.