Application of the Monti procedure in Adult Continent Cutaneous Urinary Diversion.
AJTES Vol 4, No 2, July 2020
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Monti procedure
Urinary Bladder
Urinary Diversion

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GALIQI, G., BAJRI, L., PESHA, A., KONI, A., & SHEGA, B. (2020). Application of the Monti procedure in Adult Continent Cutaneous Urinary Diversion. Albanian Journal of Trauma and Emergency Surgery, 4(2), 679-683.


Introduction; Monti and co. described in 1997 is a continent catheterizable conduit using short segments of the ileum (1). The use of this technique allows us to obtain 2 to 2.5 cm segment of the ileum to achieve a tabularized segment of 7-8 cm. The 15 cm of terminal ileum was not routinely used for this type of procedure. After the reconstruction of a tunnel, anastomosis was performed on the superior part of the posterio-lateral junction of the bladder.

Objectives: To report 6 cases using the Monti procedure with ileum for adult continent cutaneous urinary diversion, from different etiologies.

Materials and Methods: From 2007 to 2020 we treated 6 patients with different conditions with this procedure. First case was a middle-aged woman with a big vesico-vaginal fistula (fig.3) It was unappropriated to be closed with satisfactory functional results in terms of continence, because a part of the sphincter was destroyed also. The reason of damage was auto mutilation as a result of borderline personality.

Discussion: Monti procedure associating Mitrofanoff principle was mainly used in pediatric patients (1,2,3) That’s because of the relatively easy execution of the “Mitrofanoff principle” and the high degree of continence obtained with its use (4). But can we use the same principle to resolve some difficult cases in adult urology also?

Conclusion: The Monti tunnel is a valid option for continent intermittent catheterisation. It’s also an alternative to be adjunct with Mitrofanoff procedure when needed. We used it when the appendix was not appropriate to be used as a tunnel or when it was missing. It has a good continent percentage and it can be done rather easily. Of course, ours is a small series of cases to represent more important conclusions.
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2. Mitrofanoff P. Cystostomie continente trans-appendiculaire dans le traitement des vessies neurologiques. Chir Pediatr. 1980; 21: 297-305
3. Duckett J. Use of the Mitrofanoff principle in urinary reconstruction. Urol Clin North Am. 1986; 13: 271-274
4. Sumfest J.M. The Mitrofanoff principle in urinary reconstruction. J Urol. 1993; 150: 1875-1878
5. Hadley D1, Anderson K1, Knopick CR2, Shah K2, Flynn BJ3. Creation of a continent urinary channel in adults with neurogenic bladder: long-term results with the Monti and Casale (Spiral Monti) procedures. Urology. 2014 May;83(5):1176-80.
6. Hosseini J1, Kaviani A, Mazloomfard MM, Golshan AR. Monti's procedure as an alternative technique in complex urethral distraction defect.Int Braz J Urol. 2010 May-Jun;36(3):317-26.
7. Travis J. Pagliara Ronak A. Gor University of Minnesota Outcomes of revision surgery for difficult to catheterize continent channels in a multi-institutional cohort of adults. :
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