Treatment Outcomes for Female Neurogenic Bladder Urinary Diversion with “Monti” Construction

Objectives: The Yang-Monti (“Monti”) is a technique of urinary diversion that is an alternative to the appendicovesicostomy for patients with neurogenic bladder dysfunction. The technique involves creation of a continent catheterizable conduit to the bladder using a small portion of reconfigured ileum. While the Monti technique has been extensively used in pediatric patients, there is limited information in adult women. Therefore, the purpose of this study was to evaluate “Monti” outcomes in a female adult population with neurogenic bladder.

Methods: Between 2010 and 2023, “Monti” procedures at a single institution were identified using CPT codes, and reviewed to select for adult female patients with neurogenic bladder dysfunction. Preoperative evaluation included baseline status, surgical indication and sociodemographic data. Perioperative (<30 days post-operative) variables included intraoperative and perioperative complications. Long-term variables were defined as >30 days post-operative and included infections, hospital admissions, treatments and reoperations. Descriptive data are presented as means or percentages.

Results: A total of 23 adult patients were identified including 14 females with neurogenic bladder dysfunction for analysis. The mean age was 37± 13.9 years with BMI 26± 6 kg/m². The majority of the patients were white (78%) and 14% were black. Most patients developed neurogenic bladder secondary to trauma, while other indications for surgery included congenital abnormalities (n=2), progressive multiple sclerosis (n=1), tumors (n=2), and autoimmune neuropathy (n=1). The mean operative time was 260.4± 85.9 minutes and estimated blood loss (EBL) 107±82 ml with rare (n=1) intraoperative complication. Average length of stay was 5.8±3.2 days and return of bowel function was seen at 3.1±1.7 days (figure 1). Perioperative complications occurred in 6 patients (40%) in the first 30 days however most were minor: UTIs (n=1), surgical site infection (n=1), small bowel obstruction (n=1), and suprapubic tube related complications (n=3). At six month follow-up 6 patients were receiving botulinum toxin-A. There were a total of 27 emergency department visits for any reason and nine reoperations. The mean follow up time was 2.1±2 years.

Conclusions: “Monti” procedures are a useful tool for adult female patients with neurogenic bladder dysfunction. As opposed to the appendicovesicostomy the Monti technique provides consistent anatomy for urinary diversions. However, these procedures are associated with complications and this information can be used to guide patient selection and counseling.