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Yang-Monti Channel (Monti Ileovesicostomy)

The Yang-Monti channel (Monti ileovesicostomy) is a continent catheterizable channel created by transversely retubularizing a short segment of bowel, most commonly ileum, over a small-caliber catheter to convert a wide, short bowel ring into a longer narrow tube. It is an established bowel-based alternative to appendicovesicostomy when the appendix is unavailable, unsuitable, or already committed to a Malone antegrade continence enema (MACE).[1][2][3] A tubularized bladder flap is another option when sufficient suitable bladder tissue is available.[19][20]

For the design rules behind every catheterizable conduit (flap-valve mechanics, tunnel length, fixation), see Principles of Continent Catheterizable Channels.

Yang-Monti retubularization: Ileal segment, conceptual construction sequence

Opening a short ileal segment and retubularizing across the original axis converts bowel circumference into channel length. Sizes are illustrative; pedicle geometry, catheterization and exact variant construction need technical review. (Original WARWIKI schematic; see the figure source record and review limits.)

Historical Background​

Transverse retubularization of ileum for a continent catheterizable conduit was described by Yang in 1993 and studied in dogs by Monti and colleagues in 1997, hence the combined eponym.[45][46][42] Castellan's clinical Monti series and Van Savage's sigmoid adaptation were later applications.[6][22] Early human series followed in 1998 and 1999.[3][4][5][6]

Indications​

IndicationNotes
Neurogenic bladder (spina bifida, SCI, tethered cord)Most common indication in the cited cohorts; the appendix may be used for MACE.[1][2][10] For children with spinal dysraphism who have difficulty performing urethral CIC, the 2025 EAU–ESPU guideline recommends offering a continent catheterizable channel . Check that the planned stoma is reachable for catheterization; if CIC by any route is not feasible and diversion is needed for upper tract deterioration, consider incontinent diversion.[44]
Bladder exstrophy–epispadias complexAppendix often used previously or absent.[1][2]
Post-cystectomy continent cutaneous urinary diversionAdult continent diversion when appendix is unavailable.[7][8]
Devastated bladder outletOften combined with bladder neck closure and augmentation.[10]
MACE for fecal incontinenceBowel-segment alternative when appendix is needed for the urinary channel.[1][14]
Long ureteral defectsSame retubularization principle applied as a Yang-Monti ileal ureter.[15][16][17]

Surgical Technique​

Bowel-segment isolation and vascular pedicle​

A 2–2.5 cm segment of ileum is isolated 15–20 cm proximal to the ileocecal valve on its mesenteric pedicle, and donor-bowel continuity is restored. When a channel is harvested beside a simultaneous augmentation patch, the shared harvest can avoid a separate bowel anastomosis.[3] The vascular advantage of the Monti is that the mesentery enters the segment centrally, so when the bowel is opened and retubularized transversely, the blood supply runs through the midpoint of the resulting tube and perfuses both ends, while the appendix has its own mesoappendiceal vascular pedicle. Neither arrangement guarantees freedom from ischemia.[5][6]

Two practical extensions of the same principle:

  • Combined channel and augmentation from a single pedicle. A longer ileal segment can be harvested, with 2–2.5 cm separated for the channel and the remainder detubularized as the augmentation patch, all sharing one mesentery. Ten of 29 tubes (34.5%) were made with a simultaneous augmentation patch on the same pedicle in Castellan's series.[5][6]
  • Sigmoid colon as an alternative segment. When the appendix is allocated to MACE and the dilated sigmoid of a neurogenic-bowel patient is available, a single sigmoid segment yields a tube of approximately 10–15 cm, often enough to reach the umbilicus without a double Monti (5 children in the original sigmoidovesicostomy report).[22] Sigmoid was used in 11 of 18 Yang-Monti urinary channels in Lemelle's series.[1]

Ischemic stenosis can require a replacement channel: Castellan reported three affected patients among 25 with 29 urinary or enema tubes at mean 13 months.[6]

Retubularization​

The bowel is opened along its antimesenteric border with a longitudinal incision, converting the cylinder into a flat rectangular sheet. The sheet is rolled transversely (perpendicular to the original bowel axis) over a 12–16 Fr catheter template and closed with a running absorbable suture (4-0 or 5-0).[5][6][3] Gerharz's early clinical series used a 2 cm ileal segment opened about 1 cm from the mesentery and retubularized over a 14 Fr catheter; 13 of 16 patients (81%) were continent day and night.[4]

  • A 2–2.5 cm ileal segment yields a tube 5–6 cm long; the tube length equals the original bowel circumference.
  • Ileal segment length determines the potential tube caliber; the catheter template calibrates the lumen during retubularization.[42]
  • Orient the reconfigured segment and vascular pedicle to avoid twisting, tension or catheter obstruction.

Continence mechanism — the flap-valve tunnel​

The continence mechanism recapitulates the ureterovesical junction flap valve (the Mitrofanoff principle): as the reservoir fills, intraluminal pressure compresses the channel against its backing wall, creating a one-way valve that resists efflux while still permitting catheter passage.[23][24]

Three implantation strategies are in routine use:

TunnelConstructionNotes
Submucosal (intravesical)Bladder is opened; submucosal trough developed between mucosa and detrusor; channel laid in trough; mucosa closed over channel.Aim for an approximately 5 cm tunnel (5:1 tunnel-to-diameter, mirroring ureteral reimplantation).[23][24] Watson urodynamics: functional profile length was associated with continence around 2 cm in 21 mixed conduits.[25]
Extravesical (Lich-Gregoir–type)3–6 cm detrusor incision; seromuscular flaps brought anteriorly over the channel; no large cystotomy.Stomal continence in 79 of 84 patients (94%), 37 of them with Monti channels.[26]
Serosa-lined extramural (Ghoneim)Channel positioned on the serosal surface of the augmentation bowel patch; bowel imbricated over it.Useful when the channel must reach the umbilicus, because the tunnel lies on the augmentation segment rather than native bladder.[8][27]

A 17-adult feasibility study found absence of an initial filled-reservoir pressure peak in the five patients leaking at low detrusor pressure. This supports a role for the intravesical tunnel.[28]

Bladder-to-abdominal-wall fixation at the channel exit has been described to preserve tunnel length and limit angulation.[26]

Stoma construction​

The umbilicus is one common option; prioritize reachable, tension-free access in the patient’s usual position over a universal preferred site.[29][30]

  • Triangular skin-flap technique (Bissada): a triangular flap is raised to the right of the umbilicus, a 1 cm piece of umbilical scar is excised, and the spatulated channel (appendix, tapered ileum or gastric tube in the original report) is anastomosed to the apex of the flap, concealing the stoma in the natural umbilical depression. Bissada reported satisfactory cosmesis in all 95 patients, with 3 simple revisions and 4 dilations.[30]
  • Choose the abdominal-wall course to support easy catheter passage without constriction.[28][9]
  • A flush V-flap stoma is commonly used to maintain cosmesis and clothing fit.[7][30]

A retrospective series of 60 appendiceal or ureteral channels (mean follow-up 3 years) reported stenosis in 13% of umbilical versus 4% of lower-quadrant stomas. The groups used different channel tissues.[29]

Channel routing and angulation prevention​

The path from reservoir to skin must be straight and tension-free. Elongation or angulation of the channel (7 patients) and deficient tunnel length (8) were the main indications for bladder or channel revision among 17 patients in Cain's series of 199.[18]

  • Plan fascial passage and fixation to avoid compression and angulation.
  • Bladder hitching can be used when fixation is needed to achieve a tension-free, well-aligned channel.[26] In a retrospective cohort, revision or replacement for difficult catheterization occurred in 1/21 hitched versus 8/84 unhitched channels (p = 0.68); routine hitching has not been shown to reduce complications.[37]
  • In the Riley retrospective comparison, subfascial revision was required in 15.2% of Casale (spiral Monti) channels versus 8.3% of standard Monti channels; the need was highest for spiral channels placed in the umbilicus.[9] In a later, overlapping Riley cohort of 510 pediatric patients, estimated 10-year subfascial revision risk was 8.6% for appendiceal channels, 15.5% for Monti channels other than umbilical spiral Monti, and 32.3% for umbilical spiral Monti. Adjusted revision hazards relative to appendix were 2.09 and 4.23 for the latter two Monti groups, respectively.[41]

Variations​

The standard single Monti yields a tube length equal to the circumference of the bowel used, typically only 5–6 cm from a 2–2.5 cm ileal segment. That is often inadequate in adults, in obese patients, or whenever the stoma must reach the umbilicus. The double Monti and Casale (spiral Monti) lengthen a transversely retubularized ileal channel; a longitudinally tapered ileal channel is a separate longer-channel option.[3][33] Transverse sigmoid retubularization has been described for urinary access.[1][22] Gastric tubes have been described for urinary catheterizable access using a different construction; the cited Bruce series used a gastric tube for antegrade-enema access.[43][13]

Double Monti​

A composite channel built from two separate 2–2.5 cm ileal segments retubularized independently and anastomosed end-to-end.[6][9][10]

Steps

  1. Select two short ileal segments with preserved vascular attachments; they may be adjacent portions of one harvest. Plan and restore bowel continuity according to the harvest rather than assuming two separate bowel resections are required.
  2. Open each segment longitudinally near the mesentery so transverse retubularization creates a short and a long end; orient the short ends for the end-to-end join, leaving the mesenteric pedicles centrally.[3]
  3. Retubularize each transversely over a 12–16 Fr catheter with a running 4-0 or 5-0 absorbable suture; each yields a 5–6 cm tube.
  4. End-to-end anastomose the two retubularized tubes for a composite channel of approximately 10–12 cm.
  5. Implant via submucosal, extravesical, or serosa-lined extramural tunnel; flush stoma at the chosen site.

Vascular caveat. Each tube retains a central mesenteric pedicle; preserve both pedicles and assess perfusion at the end-to-end join.[3] Ischemic stenosis was reported in 3 of 25 patients (12%) in the original Castellan/Gosalbez series, all requiring a new channel. The available original abstract does not identify all three as double tubes, so it cannot supply a double-Monti-specific 12% risk.[6]

Use it when

  • Casale is not feasible (limited contiguous ileum from prior bowel surgery).
  • Two different bowel segments are needed for anatomic reasons (one ileal, one colonic).
  • Surgeon preference and familiarity.
  • In Hadley's 26-adult series of benign bladder disease (22 with known neurologic disease and 4 with a devastated bladder outlet), a double Monti was used in 27% (7/26), a Casale in 69% (18/26) and a single Monti in one patient.[10]

PGIMER pouch (double-T continent diversion). The double-Monti principle has been carried into continent cutaneous diversion: Yang-Monti tubes are fashioned from the proximal and distal ends of a 45–50 cm ileal segment. The proximal tube serves as the afferent limb for ureteral implantation (Wallace principle); the distal tube(s) function as the efferent catheterizable channel. Both are implanted via serosa-lined extramural tunnels (Ghoneim). In an early 8-patient series, 14 of 15 anastomoses were nonrefluxing, with intestinal obstruction (n = 2) and ureteroileal anastomotic leak (n = 3) early in the learning curve.[8]

Casale (Spiral Monti)​

Casale described the spiral Monti in 1999 in 8 patients. It creates a long channel from a single piece of bowel on a single mesenteric pedicle and avoids the end-to-end anastomosis of a double Monti.[11]

Steps

  1. Isolate a single 3.5 cm ileal segment on its mesenteric pedicle.
  2. Divide the isolated segment transversely into two rings through about 80% of its circumference, leaving the bowel over the mesentery connected. Then open each ring adjacent to the mesentery on opposite sides.[11]
  3. Unfold the bowel into a single long strip whose two halves remain connected through the intact mesenteric bridge (a zigzag or S-shape approximately twice the length of a standard Monti).
  4. Retubularize the strip transversely over a 12 Fr catheter with running absorbable suture, yielding a 10–14 cm tube.
  5. Trim and spatulate the ends as needed for stomal maturation and bladder implantation.

Vascular design. The bridge permits construction without an end-to-end tube anastomosis, but perfusion still depends on careful preservation and untwisted routing.[12]

Tapered Monti​

A tapered ileal channel reduces the caliber of a longitudinal bowel segment and is different from transverse Yang-Monti retubularization. Descriptions vary by reservoir and implantation method; do not conflate it with a single standardized “tapered Monti.” Excisional tapering necessarily opens the bowel wall before closure.[12][33][34]

Galansky's 69-child retrospective study included appendiceal, tapered ileal and enema channels. The tapered ileal channels were performed only by an open approach. Its approximately 91% open-versus-robotic continence figures apply to the mixed groups. No direct evidence establishes the strongest blood supply or lowest dilation risk among all three variants.[12]

Comparing lengthening options​

OptionConstructionPractical limitation
Double MontiTwo retubularized short segments joined end-to-endRequires a patent, well-perfused join and adequate reach.
CasaleOne partially divided bowel segment unfolded and retubularizedRequires preservation of its connecting bridge and careful routing.
Tapered ileumLonger segment narrowed along its original axisDifferent construction; bowel use and implantation vary.

Outcomes side-by-side (Riley, n = 188; mean follow-up 43 mo). Standard Monti (n = 109) versus Casale (n = 79):[9]

  • 98% stomal continence overall.[9]
  • Stomal revision: 10.1% (Monti) versus 7.6% (Casale), not significant.[9]
  • Subfascial revision 9/109 (8.3%) for Monti versus 12/79 (15.2%) for Casale.[9] The paper highlights higher revision with umbilical placement, especially spiral channels.
  • Endoscopic procedures requiring anesthesia were performed in 17 patients (9.0%).[9]

In Hadley's adult series, Casale channels were used in 69% (18/26) and double Monti in 27% (7/26).[10]

Choosing the channel​

Measure the required reservoir-to-skin distance, including backed tunnel length. A single Monti is typically only 5–6 cm; some distances under 10 cm require a longer channel. Choose a longer construction when necessary without stretching the pedicle or leaving excess redundancy. Compare bowel availability, prior operations, stoma accessibility and surgeon experience.[3][9][11]

In Hadley's 26-adult mixed Monti/Casale cohort, continued self-catheterization was reported in 89% with BMI <30 kg/m², 50% with BMI 30–40 kg/m², and 25% with BMI >40 kg/m². Small, nonrandomized subgroups show that access can be difficult despite an intact channel.[10]

Quality of life​

In a 12-adult Casale spiral Monti series at a mean of 2.8 years, all 12 patients reported excellent urinary continence and were very satisfied. Two wore a light pad over the stoma, two needed one endoscopic dilation each for stomal stenosis, and 8 reported no UTI since surgery. Only 7 of the 12 could self-catheterize. The authors reported improved social independence and convenient bladder management.[35]

Sigmoid and gastric variants​

The Yang-Monti principle has been applied to the sigmoid colon (longer tube from a single segment when ileum is committed elsewhere)[1][22] and gastric tubes have been described for antegrade-enema access.[6][13]

Adults and Obese Patients​

Adults often need greater reach; the Casale (spiral Monti) is one longer-channel option. In one adult series with mean BMI 30.5, the proportion successfully self-catheterizing through the umbilical stoma fell with rising BMI and was a major determinant of stomal usability, a practical limitation in morbidly obese patients.[10]

Minimally Invasive Approaches​

Laparoscopic and robotic channels have been described. Rey included only four double Yang-Monti channels among 15 adults; Galansky performed tapered ileal channels only open.[12][21]

Catheter Selection and Postoperative Management​

  • 12–14 Fr catheter for routine intermittent catheterization through the channel.
  • An indwelling catheter supports drainage during initial healing; transition to CIC and catheter size are set by the operating team according to healing and concomitant reconstruction, often after several weeks.
  • Regular catheterization is needed; intervals often start around 4–6 hours but must reflect reservoir capacity, urine production and the treating team’s plan. In one retrospective study of mixed urinary/enema channels, poorer adherence was associated with stenosis and revision.[32]
  • In this mixed urinary and enema channel study, higher weight-for-age was associated with stomal stenosis; no interpretable percentile cut-off was reported. Assess body habitus and stomal access directly.[32]

Outcomes​

  • Selected cohorts report high stomal continence, often after treatment; results depend on channel type, reservoir and outcome definition.[12][2][18][9]
  • In 199 pediatric patients followed at mean 28 months, 97.5% were still using the channel and leakage was reported in 4/115 assessed for that outcome (3.5%), not 4/199.[18]
  • Small comparative studies did not always detect a continence difference; Lemelle’s 93.8% refers to 61/65 urinary and enema channels still in use.[1][9]
  • Mixed open and robotic CCC groups had approximately 91% stomal continence in Galansky.[12]

Revision remains a frequent long-term burden, while continued channel use is a separate outcome. In a retrospective cohort of 561 people with appendiceal or Monti channels for neuropathic bladder, estimated continued use after adjustment for differential follow-up was 89% at 10 years and 81% at 20 years.[38] Nonmechanical reasons accounted for 64% of disuse; catheterization by others and lack of transition-clinic attendance were associated with nonmechanical disuse.[38] In Polm 2024 (173 channels, median follow-up 12.4 years), 92/173 channels required any revision, and major revision occurred in 31/51 Monti channels compared with 27/90 appendiceal and 12/32 bladder-flap channels.[20] Lifelong urological surveillance is needed.[19][20]

Complications​

ComplicationIncidenceManagement
Stomal stenosisRevision for stomal stenosis: 11/199 Monti patients (5.5%, Cain 2008); stomal stenosis occurred in 4/25 Monti channels (16%, Narayanaswamy); stenosis requiring revision occurred in 33% of a mixed-channel pediatric series (117 channels; median follow-up 85 mo).Dilation; minor revision; V-flap revision for recurrent stenosis.[18][31][19]
Catheterization difficulty8% minor difficulty (16/199, Cain 2008); 15/25 (60%) of Monti channels in NarayanaswamyEndoscopic intervention; catheter resizing; rerouting.[18][31] If the channel is the only outlet and cannot be catheterized, Pagliara and colleagues describe this as requiring emergency intervention to drain the reservoir.[39] With a patent urethra, their expert algorithm uses a urethral catheter to decompress before another gentle channel attempt; repeated blind attempts risk a false passage, so early endoscopy is used if trauma is suspected.[39][36] Temporary indwelling catheterization after guided access has been described to maintain patency.[39][36]
Channel elongation / angulation, deficient tunnelIndications for revision: elongation/angulation in 7/199 and deficient tunnel in 8/199 (Cain); all-cause subfascial revision was 9/109 (8.3%) for standard Monti and 12/79 (15.2%) for Casale (Leslie).Assess channel course and tunnel; subfascial revision or selective bladder hitch when indicated.[18][9]
False passage9% (mixed channel types, pediatric series)Catheterization technique counseling; endoscopic management.[19]
Stomal incontinenceCain 2008 reported Monti-channel leakage in 4/115 assessed patients (3.5%; mean follow-up 28 months). In Polm 2017 (overall median follow-up 85 months), incontinence occurred in 14/117 mixed pediatric channels (12%), including low-pressure leakage in 4/117 (3%); among 19 Monti channels, 6 (31%) had incontinence and 3 (16%) had low-pressure leakage.Channel leakage has been reported in Monti and mixed pediatric channel cohorts.[18][19] Reassess reservoir storage pressure and capacity by urodynamics and treat high-pressure storage before channel-directed therapy.[40] For channel-related leakage, dextranomer/hyaluronic acid bulking or tunnel revision has been described; dextran microsphere injection resolved leakage in both incontinent patients in Wagner’s eight-person adult series.[7][40]
Pouch-like channel dilation (Monti-specific)Up to 28% (one series)Catheter adjustment / observation; pouch resection for severe cases.[31]
Recurrent UTI14/26 (54%) in one adult mixed single/double Monti and Casale cohort (mean follow-up 64 mo)Antibiotic stewardship; rule out incomplete emptying.[10]
Bowel complications or bladder perforationIn the same 26-adult mixed-operation cohort, bowel complications occurred in 5/26 (19%) and bladder perforation in 1/26 (4%).Reported for the full cohort without channel-specific attribution.[10]
Major surgical revision over very long follow-up31/51 Monti channels in Polm 2024See Outcomes; major means open subfascial or complete revision.[19][20]

The pouch-dilation problem​

At mean follow-up of 25 months for Monti and 37 months for appendix, pouch-like dilation occurred in 7/25 Monti channels and was not reported among 69 appendiceal channels; all seven affected Monti channels had catheterization problems.[31] The proposed mechanism is that the circular muscle fibers of the native ileum, oriented circumferentially in the original bowel, run longitudinally in the retubularized tube and so offer little resistance to radial expansion.[31] Technical descriptions include retubularization over an appropriately sized catheter, trimming the finished channel to limit redundancy and ease catheterization, and, for a distinct construction, tapering a longitudinal ileal segment; whether these choices prevent pouch dilation is unestablished.[12][31][42]

Yang-Monti Ileal Ureter​

The same retubularization principle is used to bridge long ureteral defects. A 5 to 7.5 cm ileal segment is divided into two or three equal parts, unfolded and retubularized to create a 12–18 cm tube of ureteral caliber, which is implanted into the bladder with a submucosal antireflux technique (10 patients in the original report).[17] The approach uses a shorter ileal segment than a conventional long ileal ureter to limit urine-exposed bowel surface.[17] In 36 patients followed for a median of 68 months (median defect 11 cm), creatinine, split renography and eGFR improved overall, but four patients with stage 3 chronic kidney disease deteriorated, and the authors considered eGFR below 40 mL/min/1.73 m² a relative contraindication.[15] A laparoscopic series in 6 children has been described.[16] For the broader interposition-graft context see Ileal Ureter.

See Also​

References​

1. 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 Pt 1):1907–1910. doi:10.1097/01.ju.0000140448.36332.fc

2. Cain MP, Casale AJ, King SJ, Rink RC. Appendicovesicostomy and newer alternatives for the Mitrofanoff procedure: results in the last 100 patients at Riley Children's Hospital. J Urol. 1999;162(5):1749–1752. doi:10.1016/s0022-5347(05)68230-4

3. Leslie JA, Dussinger AM, Meldrum KK. Creation of continence mechanisms (Mitrofanoff) without appendix: the Monti and spiral Monti procedures. Urol Oncol. 2007;25(2):148–153. doi:10.1016/j.urolonc.2006.09.007

4. Gerharz EW, Tassadaq T, Pickard RS, et al. Transverse retubularized ileum: early clinical experience with a new second-line Mitrofanoff tube. J Urol. 1998;159(2):525–528. doi:10.1016/s0022-5347(01)63976-4

5. Gosalbez R, Wei D, Gousse A, Castellan M, Labbie A. Refashioned short bowel segments for the construction of catheterizable channels (the Monti procedure): early clinical experience. J Urol. 1998;160(3 Pt 2):1099–1102. doi:10.1097/00005392-199809020-00036

6. Castellan MA, Gosalbez R, Labbie A, Monti PR. Clinical applications of the Monti procedure as a continent catheterizable stoma. Urology. 1999;54(1):152–156. doi:10.1016/s0090-4295(99)00046-1

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. doi:10.1016/j.urology.2008.06.015

8. Agarwal MM, Mavuduru R, Singh SK, Mandal AK. Preliminary short-term outcomes of a modified double-T ileal continent cutaneous urinary diversion using Yang-Monti tube implantation through serosa-lined extramural tunnel: the PGIMER pouch. Urology. 2012;79(4):943–949. doi:10.1016/j.urology.2011.12.026

9. Leslie JA, Cain MP, Kaefer M, et al. A comparison of the Monti and Casale (spiral Monti) procedures. J Urol. 2007;178(4 Pt 2):1623–1627; discussion 1627. doi:10.1016/j.juro.2007.03.168

10. Hadley D, Anderson K, Knopick CR, Shah K, Flynn BJ. Creation of a continent urinary channel in adults with neurogenic bladder: long-term results with the Monti and Casale (spiral Monti) procedures. Urology. 2014;83(5):1176–1180. doi:10.1016/j.urology.2013.12.046

11. Casale AJ. A long continent ileovesicostomy using a single piece of bowel. J Urol. 1999;162(5):1743–1745. PubMed. doi:10.1016/s0022-5347(05)68228-6

12. Galansky L, Andolfi C, Adamic B, Gundeti MS. Continent cutaneous catheterizable channels in pediatric patients: a decade of experience with open and robotic approaches in a single center. Eur Urol. 2021;79(6):866–878. doi:10.1016/j.eururo.2020.08.013

13. Bruce RG, el-Galley RE, Wells J, Galloway NT. Antegrade continence enema for the treatment of fecal incontinence in adults: use of gastric tube for catheterizable access to the descending colon. J Urol. 1999;161(6):1813–1816. doi:10.1016/s0022-5347(05)68811-8

14. Herndon CD, Cain MP, Casale AJ, Rink RC. The colon flap/extension Malone antegrade continence enema: an alternative to the Monti-Malone antegrade continence enema. J Urol. 2005;174(1):299–302. doi:10.1097/01.ju.0000161215.67278.99

15. 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;152:153–159. doi:10.1016/j.urology.2020.09.061

16. Liu D, Zhou H, Hao X, et al. Laparoscopic Yang-Monti ureteral reconstruction in children. Urology. 2018;118:177–182. doi:10.1016/j.urology.2018.04.034

17. Ali-el-Dein B, Ghoneim MA. Bridging long ureteral defects using the Yang-Monti principle. J Urol. 2003;169(3):1074–1077. doi:10.1097/01.ju.0000050151.66653.cc

18. Cain MP, Dussinger AM, Gitlin J, et al. Updated experience with the Monti catheterizable channel. Urology. 2008;72(4):782–785. doi:10.1016/j.urology.2008.04.006

19. Polm PD, de Kort LMO, de Jong TPVM, Dik P. Techniques used to create continent catheterizable channels: a comparison of long-term results in children. Urology. 2017;110:192–195. doi:10.1016/j.urology.2017.08.030

20. Polm PD, Christiaans CHH, Dik P, Wyndaele MIA, de Kort LMO. Continent catheterizable urinary channels: lessons for lifelong urological care from a comparative analysis of very long-term complications and revision-free survival of three different types. Neurourol Urodyn. 2024;43(5):1083–1089. doi:10.1002/nau.25350

21. Rey D, Helou E, Oderda M, et al. 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. doi:10.1111/bju.12257

22. Van Savage JG, Yepuri JN. Transverse retubularized sigmoidovesicostomy continent urinary diversion to the umbilicus. J Urol. 2001;166(2):644–647. doi:10.1016/S0022-5347(05)66035-1

23. Kaefer M, Retik AB. The Mitrofanoff principle in continent urinary reconstruction. Urol Clin North Am. 1997;24(4):795–811. doi:10.1016/s0094-0143(05)70421-3

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25. Watson HS, Bauer SB, Peters CA, et al. Comparative urodynamics of appendiceal and ureteral Mitrofanoff conduits in children. J Urol. 1995;154(2 Pt 2):878–882. doi:10.1016/S0022-5347(01)67193-3

26. VanderBrink BA, Kaefer M, Cain MP, et al. Extravesical implantation of a continent catheterizable channel. J Urol. 2011;185(6 Suppl):2572–2575. doi:10.1016/j.juro.2011.01.027

27. Soygur T, Arikan N, Zumrutbas AE, Gulpinar O. Serosal lined extramural tunnel (Ghoneim) principle in the creation of a catheterizable channel in bladder augmentation. J Urol. 2005;174(2):696–699. doi:10.1097/01.ju.0000164742.04779.cc

28. Christiaans CHH, Polm PD, van Steenbergen TRF, Wyndaele MIA, de Kort LMO. Why are continent catheterizable channels continent? A stomal pressure profilometry feasibility study. Neurourol Urodyn. 2024;43(8):2093–2100. doi:10.1002/nau.25546

29. Van Savage JG, Khoury AE, McLorie GA, Churchill BM. Outcome analysis of Mitrofanoff principle applications using appendix and ureter to umbilical and lower quadrant stomal sites. J Urol. 1996;156(5):1794–1797. doi:10.1016/S0022-5347(01)65538-1

30. Bissada NK. Favorable experience with a simple technique to create a concealed umbilical stoma. J Urol. 1998;159(4):1174–1175. doi:10.1016/s0022-5347(01)63544-4

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