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Yang-Monti's Catheterizable Stoma in Children
Rajendra Bapusaheb Nerli1, Shivagouda Malgouda Patil, Murigendra Basayya Hiremath
1Department of Urology, KLES Kidney Foundation, JN Medical College, KLE University, Belgaum, India.
Insights
The Yang-Monti ileovesicostomy provides an effective and convenient urinary conduit for children requiring clean intermittent catheterization (CIC). This procedure demonstrates minimal long-term complications and ease of CIC for pediatric patients.
Area of Science:
- Pediatric Urology
- Surgical Reconstruction
- Urinary Diversion
Background:
- The Mitrofanoff procedure, established in 1981, enabled continent urinary stomas for clean intermittent catheterization (CIC).
- Subsequent advancements include the Yang-Monti ileovesicostomy, offering an effective alternative for catheterization.
Purpose of the Study:
- To evaluate the clinical experience and outcomes of the Yang-Monti procedure in pediatric patients at our institution.
Main Methods:
- A cohort of 19 children under 18 years underwent Yang-Monti ileovesicostomy for conditions like neuropathic bladder, bladder exstrophy, valve bladder syndrome, and urethral stricture.
- Post-operative management included teaching clean intermittent catheterization (CIC) with a 14/16 Fr catheter every 3 hours.
- Patients were followed for 24 months, monitoring catheterization success and incontinence.
Main Results:
- All 19 pediatric patients successfully performed CIC post-operatively without difficulty.
- No hindrance to catheter passage was observed in any patient.
- Indications included neuropathic bladder (8), bladder exstrophy (7), valve bladder syndrome (3), and urethral stricture (1).
Conclusions:
- The Yang-Monti ileovesicostomy is a viable and convenient conduit for pediatric urinary diversion.
- While the appendix is preferred, this method shows minimal long-term complications.
- Children find the Yang-Monti stoma comfortable and manageable for CIC.
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.
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