Laparoscopic continent cutaneous urinary diversion using a modified Yang-Monti technique in an adult: A case report including 5-year follow-up

Abstract

Continuous cutaneous urinary diversion is challenging when the appendix is physically unavailable. The Yang-Monti channel is an alternative to the tunneled appendix for urinary diversion. We present a case involving a 49-year-old man who underwent total urethrectomy and cystostomy 10 months previously. No tumor recurrence was observed; however, the patient experienced severe catheter-related bladder irritation after the procedure. The patient was readmitted to the authors’ hospital and underwent laparoscopic continent cutaneous urinary diversion using extracorporeal construction of a modified Yang-Monti channel. The operation lasted 232 minutes, with an estimated blood loss of 10 mL. The patient was discharged from hospital 6 days after surgery and removal of the cystostomy tube. After this, clean intermittent catheterization was performed every 3 hours for 4 weeks. Five years after the procedure, the modified Yang-Monti channel was still used for clean intermittent catheterization without any stomal stenosis being observed. The patient was satisfied with his postoperative quality of life.

Keywords

Cutaneous urinary diversion / Yang-Monti channel / Laparoscopy

Acknowledgments

The authors are grateful to Mrs. Xinying Ma, who helped draw an excellent illustration.

Statement of ethics

The authors are accountable for all aspects of this work and ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures were performed in accordance with the Declaration of Helsinki (revised in 2013) and were approved by the Institutional Review Board of Peking University First Hospital (approval number: 2019-134). Written informed consent was obtained from the patient for the publication of anonymized details in this case report.

Conflict of interest statement

XL is an associate editor of Current Urology. This article was accepted after a normal external review. No conflict of interest has been declared by the other authors.

Funding source

None.

Author contributions

SC: Data collection and manuscript writing;

YW: Data collection and manuscript writing;

PZ: Analysis of data;

ZL1: Analysis of data;

XL1: Analysis of data;

ZL2: Analysis of data;

XL2: Conceptualization, supervision and manuscript revision;

KY: Conceptualization, supervision and manuscript revision.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

[1] Levy ME, Elliott SP. Reconstructive techniques for creation of catheterizable channels: Tunneled and nipple valve channels. Transl Androl Urol 2016; 5(1):136-144.

[2] Mitrofanoff P. Trans-appendicular continent cystostomy in the management of the neurogenic bladder. Chir Pediatr 1980; 21(4):297-305.

[3] Yang WH. Yang needle tunneling technique in creating antireflux and continent mechanisms. J Urol 1993; 150(3):830-834.

[4] Monti PR, Lara RC, Dutra MA, de Carvalho JR. New techniques for construction of efferent conduits based on the Mitrofanoff principle. Urology 1997; 49(1):112-115.

[5] Lemelle JL, Simo AK, Schmitt M. Comparative study of the Yang-Monti channel and appendix for continent diversion in the Mitrofanoff and Malone principles. J Urol 2004; 172(5 Pt1):1907-1910.

[6] Castellan MA, Gosalbez R, Labbie A, Ibrahim E, Disandro M. Outcomes of continent catheterizable stomas for urinary and fecal incontinence: Comparison among different tissue options. BJU Int 2005; 95(7):1053-1057.

[7] Wagner M, Bayne A, Daneshmand S. Application of the Yang-Monti channel in adult continent cutaneous urinary diversion. Urology 2008; 72(4):828-831.

[8] Rey D, Helou E, Oderda M, Robbiani J, Lopez L, Piechaud PT. Laparoscopic and robot-assisted continent urinary diversions (Mitrofanoff and Yang-Monti conduits) in a consecutive series of 15 adult patients: The Saint Augustin technique. BJU Int 2013; 112(7):953-958.

[9] Zhong W, Hong P, Ding G, et al. Technical considerations and outcomes for ileal ureter replacement: A retrospective study in China. BMC Surg 2019; 19(1):9.

[10] Ali-El-Dein B, El-Hefnawy AS, D'Elia G, et al. Long-term outcome of Yang-Monti ileal replacement of the ureter: A technique suitable for mild, moderate loss of kidney function and solitary kidney. Urology 2021;152:153-158.

[11] Liu Y, Bi Y, Sun Y, Shen J, Tang L, Chen H. Outcomes of laparoscopic continent catheterizable conduit procedures in children with neurogenic bladder: An 8-year experience in a single center. J Pediatr Urol 2020; 16(4):478.e1-478.e6.

[12] Galvez C, Lopategui DM, Horodyski L, Castellan M. Totally robotic intracorporeal Monti-Yang continent ileovesicostomy in patient with previous robotic surgery-technique description. J Pediatr Urol 2021; 17(4):579-580.

[13] Fan S, Han G, Li Z, et al. Robot-assisted laparoscopic ileal ureter replacement with extracorporeal ileal segment preparation for long ureteral strictures: A case series. BMC Surg 2022; 22(1):435.

[14] Van der Aa F, Joniau S, De Baets K, De Ridder D. Continent catheterizable vesicostomy in an adult population: Success at high costs. NeurourolUrodyn 2009; 28(6):487-491.