Monti’s procedure as an alternative technique in complex urethral distraction defect

Abstract

Purpose: Pelvic fracture urethral distraction defect is usually managed by the end to end anastomotic urethroplasty. Surgical repair of those patients with post-traumatic complex posterior urethral defects, who have undergone failed previous surgical treatments, remains one of the most challenging problems in urology. Appendix urinary diversion could be used in such cases. However, the appendix tissue is not always usable. We report our experience on management of patients with long urethral defect with history of one or more failed urethroplasties by Monti channel urinary diversion. Materials and Methods: From 2001 to 2007, we evaluated data from 8 male patients aged 28 to 76 years (mean age 42.5) in whom the Monti technique was performed. All cases had history of posterior urethral defect with one or more failed procedures for urethral reconstruction including urethroplasty. A 2 to 2.5 cm segment of ileum, which had a suitable blood supply, was cut. After the re-anastomosis of the ileum, we closed the opened ileum transversely surrounding a 14-16 Fr urethral catheter using running Vicryl sutures. The newly built tube was used as an appendix during diversion. Results: All patients performed catheterization through the conduit without difficulty and stomal stenosis. Mild stomal incontinence occurred in one patient in the supine position who became continent after adjustment of the catheterization intervals. There was no dehiscence, necrosis or perforation of the tube. Conclusion: Based on our data, Monti's procedure seems to be a valuable technique in patients with very long complicated urethral defect who cannot be managed with routine urethroplastic techniques.

Management of urogenital trauma

“…In cases of unsalvageable bulbomembranous traumatic urethral strictures, various salvage procedures including continent vesicostomy [39] or interposition of tubed bowl flaps between the prostatic and distal urethral edges [40] have been described.…”

Continent ileocaecocystoplasty bladder augmentation following a failed appendicovesicostomy on pediatric bladder neck stricture due to pelvic fracture urethral injury: A case report

“…Hosseini et al mentioned that urinary diversion is a treatment of choice in patients with urethral defects which cannot be managed by urethroplasty. 2 Definitive treatment should be performed to achieve continence and patient comfort.…”

Continent Urinary Diversion with Short Appendices in Obese Patients: the Initial Results of a Surgical Option

“…(7) This procedure is also a good alternative for severe and intractable urethral stenosis. (8) Some times during the surgery, it is found a short ileocecal appendix that is insufficient to reach the skin (i.e., obese patients). In 2011, Rodrigues Jr.et al published a case report (7) using the Monti's technique (an ileal segment of 2-3 cm that is open longitudinally and reconfigured transversally, moldeled by a 12-Fr urethral cateter) associated with the Mitrofanoff's principle to solve this problem.…”