PEDIATRIC UROLOGY

Updated experience with the Monti catheterizable channel
Cain MP, Dussinger AM, Gitlin J, Casale AJ, Kaefer M, Meldrum K, Rink RC
Department of Urology, Riley Children’s Hospital, Indiana University School of Medicine, Indianapolis, Indiana, USA
Urology. 2008; 72: 782-5

• Objectives: The Monti catheterizable channel is used as an integral part of continent bladder reconstruction in children. We have updated our ongoing experience at Riley Children’s Hospital with 199 patients.
• Methods: We identified 199 patients for retrospective review, including all patients for whom a Monti ileovesicostomy was created from January 1997 to August 2004. We assessed the complications, surgical procedures, and stomal continence.
• Results: At mean follow-up of 28 months, we found that 194 of 199 patients (97.5%) continued to use their Monti catheterizable channel for bladder drainage. Early surgical complications occurred in 7 patients (3.5%), usually in those who had undergone simultaneous bladder augmentation (5 of 7). Revision was required in 16 patients (8%) for stomal stenosis (n = 11), prolapse (n = 2), or superficial stomal problems (n = 3). Of the 199 patients, 17 (8.5%) required 19 bladder or channel revisions. The primary indications were related to elongation and angulation of the channel in 7 and deficient tunnel length in 8. Minor difficulty with catheterization was noted in 16 patients (8%), and endoscopy with minor procedures was required in 4 patients (2%). Leakage from the channel was uncommon, occurring in only 4 of 115 patients (3.5%).
• Conclusions: With increasing demand for simultaneous appendicocecostomy for stool continence at bladder reconstruction, we continue to use the Monti ileovesicostomy for bladder drainage. Our experience with nearly 200 patients has demonstrated the durability and success of this technique.
  
  
• Editorial Comment
  During a seven-year period, 199 patients underwent a Monti catheterizable stoma procedure, 90 male and 109 females. Eighty-eight percent of the patients had a neuropathic bladder and over 97% of the patients underwent an additional simultaneous procedure. Seventy percent of them had bladder augmentations at the same time. Seven patients (3.5%) had early surgical complications. Sixteen (8.0%) had stomal revisions and 19 patients (9.5%) underwent channel revisions. Sixteen (8.0%) of the patients had difficulty catheterizing and 4 (3.5%) had incontinence after the channel was made.
  The authors conclude that this is a favorable outcome to a catheterizable stoma. This is their procedure of choice when the appendix is used for appendicocecostomy bowel irrigation regimen. They preferred a spiral Monti technique whenever a longer channel is required, rather than a double Monti technique.
  The authors have a mean follow up of 28 months and their results are favorable compared to their own and another study in the literature. Even though the complication rate seems high, these patients benefit greatly from a continent catheterizable stoma. Most of the complications and revisions are on the stoma and channel itself and the channel can be made functional and the patients and caregivers will be highly satisfied.
  It should be noted that one or two other complications were in non-compliant patients and particularly when a continent catheterizable stoma is considered, careful attention to patient compliance before the surgery is performed will minimize these unfortunate complications afterwards. If the catheterizable stoma is not used for a brief period of time, often it closes and cannot be recovered.

Dr. Brent W. Snow
Division of Urology
University of Utah Health Sci Ctr
Salt Lake City, Utah, USA
E-mail: brent.snow@hsc.utah.edu