Creation of a Continent Urinary Channel in Adults With Neurogenic Bladder: Long-term Results With the Monti and Casale (Spiral Monti) Procedures

Objective To describe our technique and long-term results with creation of a continent urinary channel in adults with neurogenic bladder (NGB) using a single piece of bowel. Methods From 2004 to 2013, 26 adult patients underwent creation of a continent urinary channel by a single surgeon. A retrospective medical record review was performed noting the indications, technique, concomitant procedures, complications, and outcomes. Continence outcome, ease of catheterization, and need for further surgical interventions are reported. Results Twenty women and 6 men were identified with a mean age of 48 years (range, 25-80) and a follow-up of 64 months (range, 22-100). The mean body mass index (BMI) was 30.5 kg/m 2 (range, 20.1-50.2). All patients had benign bladder disease, including 22 (85%) with known neurologic disease and 4 with a devastated bladder outlet. Creation of a continent urinary channel was performed using the single Monti tube in 1, double Monti tube in 7, and the Casale (Spiral Monti) in 18. Mean hospital stay was 10.5 days (range, 5-37). The most common complication was recurrent urinary tract infection that occurred in 14 patients (54%). There were 5 (19%) bowel complications and 1 (4%) bladder perforation. The percentage of patients continuing to catheterize via the stoma with a BMI of  2 , between 30 and 40 kg/m 2 and >40 kg/m 2 was 89%, 50%, and 25%, respectively. Conclusion The Monti and Casale procedures are effective in creating a long continent urinary channel for catheterization in the adult population with neurogenic bladder, regardless of BMI. However, despite an intact channel, stomal self-catheterization appears to be challenging in morbidly obese patients.