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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 the primary alternative to appendicovesicostomy when the appendix is unavailable, unsuitable, or already committed to a Malone antegrade continence enema (MACE).[1][2][3]

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

Historical Background​

The technique was independently described by Yang (1993) and Monti (1997), hence the combined eponym. Yang demonstrated transverse retubularization of a bowel segment in a canine model; Monti refined and popularized the operation clinically. Early human series followed in the late 1990s.[3][4][5][6]

Indications​

IndicationNotes
Neurogenic bladder (spina bifida, SCI, tethered cord)Most common indication; appendix may be diverted to MACE.[1][2][10]
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. The defining 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 — in contrast to the single end-artery of the appendix.[5][6]

Two practical extensions of the same principle:

  • Combined channel + 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. This was used in 34.5% of cases in one large 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. Sigmoid was used in 11 of 18 Yang-Monti channels in one series.[1][22]

Ischemic stenosis of the tube — the most feared vascular complication — is reported in 4–12% and typically requires creation of a new channel.[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]

  • A 2–2.5 cm ileal segment yields a tube 5–6 cm long; the tube length equals the original bowel circumference.
  • The luminal caliber is set by the catheter template.
  • The suture line should face the mesenteric side to be protected within the submucosal tunnel.

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 ~5 cm tunnel (5:1 tunnel-to-diameter, mirroring ureteral reimplantation).[24] Watson urodynamics: functional profile length ≥2.0 cm is the threshold for clinical continence.[25]
Extravesical (Lich-Gregoir–type)3–6 cm detrusor incision; seromuscular flaps brought anteriorly over the channel; no large cystotomy.94% continence in a 84-patient series (37 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 — places the tunnel on the augmentation segment rather than native bladder.[8][27]

Stomal pressure profilometry has shown that continent channels exhibit three discrete pressure peaks corresponding to the intravesical tunnel, the rectus fascia, and the skin level. Patients with stomal incontinence consistently lack the first peak — confirming that the surgically created tunnel is the dominant contributor to continence.[28]

Bladder-to-abdominal-wall fixation at the channel exit site preserves tunnel length and minimizes angulation as the patient grows or gains weight.[26]

Stoma construction​

The umbilicus is the preferred stomal site for cosmesis and patient acceptance.[29][30]

  • Triangular skin-flap technique (Bissada): a triangular flap is raised right of the umbilicus, a 1 cm rim of umbilical scar is excised, and the spatulated channel is anastomosed to the apex of the flap, concealing the stoma in the natural umbilical depression.[30]
  • The channel is brought through the rectus muscle (not lateral to it) to provide muscular support and an additional continence point at the fascial level.[28][9]
  • A flush V-flap stoma is preferred over a protruding stoma to maintain cosmesis and clothing fit.[7][30]

Stomal stenosis is more common at the umbilicus (13%) than at lower-quadrant sites (4%), reflecting the thicker subcutaneous tissue and tighter fascial opening at the umbilicus.[29]

Channel routing and angulation prevention​

The path from reservoir to skin must be straight and tension-free. Kinking is a leading cause of catheterization difficulty and reoperation.

  • Pass the channel through the rectus muscle rather than lateral to it.
  • Hitch the bladder dome to the anterior abdominal wall so the tunnel does not elongate as the bladder cycles.[26]
  • Casale (spiral Monti) channels routed to the umbilicus carry a higher subfascial-revision rate (15.2% vs 8.3%) because the longer channel takes a more tortuous path through the abdominal wall.[9]

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. Three modifications address this length problem: the double Monti, the Casale (spiral Monti), and the tapered Monti. Sigmoid and gastric segments can be substituted for ileum when needed.

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. Isolate two 2–2.5 cm ileal segments on separate mesenteric pedicles, 15–20 cm proximal to the ileocecal valve. Restore intestinal continuity at the intervening segment.
  2. Open each along its antimesenteric border into a flat sheet.
  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 ~10–12 cm.
  5. Implant via submucosal, extravesical, or serosa-lined extramural tunnel; flush stoma at the chosen site.

Vascular caveat. Each tube has reliable central mesenteric perfusion in isolation, but the end-to-end anastomosis between them creates an ischemic watershed. Ischemic stenosis was reported in 3 of 25 patients (12%) in the original Castellan/Gosalbez series, all requiring a new channel — and the affected patients had double tubes.[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 adult neurogenic-bladder series (n = 26) the double Monti was used in 27% (7/26), with Casale preferred in the remaining 69%.[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)​

Described by Casale in 1999, the spiral Monti achieves a long channel from a single piece of bowel on a single mesenteric pedicle, eliminating the watershed anastomosis.[11]

Steps

  1. Isolate a single 3.5 cm ileal segment on its mesenteric pedicle.
  2. Incise longitudinally along the antimesenteric border, then divide each resulting bowel ring adjacent to but on opposite sides of the mesentery — one ring cut left of the mesentery, the other cut right — for ~80% of the circumference, leaving the mesenteric portion intact.[11]
  3. Unfold the bowel into a single long strip whose two halves remain connected through the intact mesenteric bridge — a zigzag/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 advantage. The mesentery is never divided, so a single continuous pedicle perfuses the entire channel — no watershed. The tradeoff is that the central connection point is narrower than in unmanipulated ileum, which is one reason some centers prefer the tapered Monti for an even more robust intramural blood supply.[12]

Tapered Monti​

Some centers use a tapered ileal Monti as a third length-gaining option. A longer ileal segment (~8–10 cm) is isolated, and excess antimesenteric bowel wall is excised longitudinally to reduce the caliber to 12–14 Fr — without ever opening the bowel for retubularization.[12][33][34]

  • Bowel is never opened and reconfigured, so the intramural vascular plexus stays intact — the most robust blood supply of the three length-gaining variants.[12]
  • The native muscular orientation is preserved, lowering the risk of pouch-like dilation.
  • Achievable from a single pedicle.
  • Galansky reported the tapered Monti as their preferred variant for both open and robotic programs, with 91% continence.[12]

Head-to-head: Double Monti vs Casale vs Tapered Monti​

FeatureDouble MontiCasale (Spiral Monti)Tapered Monti
Bowel inputTwo separate 2–2.5 cm segmentsSingle 3.5 cm segmentSingle ~8–10 cm segment
Channel length~10–12 cm~10–14 cmVariable (length set by harvest)
Mesenteric pediclesTwoOne (intact bridge)One
Anastomosis requiredYes (end-to-end)NoNo
Ischemic watershedYes (at anastomosis)No (narrower bridge but continuous)No
Bowel reconfigurationYes (each tube)Yes (spiral)No (tapered only)
Pouch-dilation riskHighestModerateLowest (native orientation)
Catheter size12–16 Fr12 Fr12–14 Fr
Open vs roboticBoth describedBoth describedGalansky's preferred robotic variant

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

  • Continence equivalent at 98% in both groups.
  • Stomal revision 10.1% (Monti) vs 7.6% (Casale) — not significant.
  • Subfascial revision 8.3% (Monti) vs 15.2% (Casale) — only statistically significant difference, driven by Casale channels routed to the umbilicus traversing a longer, more tortuous fascial path.
  • Endoscopic procedures 9.0% overall, no group difference.

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

Decision algorithm​

  • Length needed under ~10 cm: standard single Monti.
  • Length 10–14 cm with single-pedicle, anastomosis-free preference: Casale.
  • Length 10–14 cm but stoma planned at umbilicus: weigh the 15.2% Casale subfascial-revision rate against the 12% double-Monti ischemic-stenosis risk.
  • Limited contiguous ileum from prior bowel surgery: double Monti.
  • Mixed bowel segments needed (e.g., one ileal + one colonic): double Monti.
  • Robotic program / desire for maximal vascular safety: consider tapered Monti.
  • BMI >30: all variants struggle; self-catheterization success drops to ~50% with BMI 30–40 and ~25% with BMI >40 regardless of technique.[10]

Quality of life​

In a 12-adult Casale spiral Monti series at 2.8-year follow-up, all 12 reported excellent urinary continence and "very satisfied" status, with two requiring endoscopic dilation for stomal stenosis and 8 of 12 reporting no UTI since surgery — described by patients as a dramatic improvement in social independence and 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 to stomach for catheterizable access.[6][13]

Adults and Obese Patients​

Adults more often need a longer channel and the Casale (spiral Monti) is usually preferred. 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​

Both laparoscopic and robot-assisted Yang-Monti construction have been described with comparable functional outcomes to open surgery. Robotic series report shorter length of stay, less postoperative pain, and improved cosmesis. Continence rates are ~91% and equivalent between open and robotic approaches.[12][21]

Catheter Selection and Postoperative Management​

  • 12–14 Fr catheter for routine intermittent catheterization through the channel.
  • Catheterization is started at 2–3 weeks postoperatively after the stoma and tunnel have healed; an indwelling catheter sits across the channel during initial healing.
  • Regular catheterization every 4–6 hours is essential — noncompliance is strongly associated with stomal stenosis (p = 0.001) and revision (p = 0.004).[32]
  • Patients above the 100th percentile for body weight have significantly higher rates of stomal stenosis.[32]

Outcomes​

  • Continence 91–98% across large pediatric and adult series.[12][2][18][9]
  • In 199 pediatric patients followed at mean 28 months, 97.5% were still using the channel and only 3.5% had stomal leakage.[18]
  • Comparative studies show no significant outcome difference between Yang-Monti and appendicovesicostomy for continence.[1][9]
  • Continence is comparable between open and robotic approaches at ~91%.[12]

The trade-off lies on the revision side. In Polm 2024 (median >12 years follow-up), ~52% of Monti channels required some surgical revision, materially higher than appendicovesicostomy — underscoring the need for lifelong urological surveillance.[19][20]

Complications​

ComplicationIncidenceManagement
Stomal stenosis8–33% (most frequent; rises with longer follow-up)Dilation; minor revision; V-flap revision for recurrent stenosis.[2][18][31]
Catheterization difficulty~8%Endoscopic intervention; catheter resizing; rerouting.[18]
Channel elongation / angulation, deficient tunnel8–15%Subfascial revision; bladder hitch.[18][9]
False passage~9%Catheterization technique counseling; endoscopic management.[31]
Stomal incontinence3.5–12%Often Deflux (dextranomer/HA) injection; tunnel revision if refractory.[7][31]
Pouch-like channel dilation (Monti-specific)Up to 28% (one series)Catheter adjustment / observation; pouch resection for severe cases.[31]
Recurrent UTIUp to 54% in adultsAntibiotic stewardship; rule out incomplete emptying.[10]
Major surgical revision over very long follow-up~52%See Outcomes; applies equally to Casale variant.[19][20]

The pouch-dilation problem​

Dilation of the retubularized segment is specific to Monti channels and is not seen with appendicovesicostomy. 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] Prevention strategies include tight retubularization over an appropriately sized (not oversized) catheter, avoidance of redundant bowel length (>2.5 cm), and tapering of the channel to reduce caliber.[12][31]

Yang-Monti Ileal Ureter​

The same retubularization principle is used to bridge long ureteral defects. Two or three 2.5 cm ileal segments are retubularized and anastomosed to create a 12–18 cm tube of ureteral caliber, implanted into the bladder with an antireflux technique. The approach uses minimal bowel — avoiding the metabolic and absorptive burden of a long ileal-ureter conduit — and has shown durable improvement in renal function at median 68-month follow-up. For the broader interposition-graft context see Ileal Ureter.[15][16][17]

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.

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.

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:10.1097/00005392-200108000-00085

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

24. Woodhouse CR. The Mitrofanoff principle for continent urinary diversion. World J Urol. 1996;14(2):99–104. doi:10.1007/BF00182565

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:10.1097/00005392-199508000-00152

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:10.1097/00005392-199611000-00094

30. Bissada NK. Favorable experience with a simple technique to create a concealed umbilical stoma. J Urol. 1998;159(4):1174–1175.

31. Narayanaswamy B, Wilcox DT, Cuckow PM, Duffy PG, Ransley PG. The Yang-Monti ileovesicostomy: a problematic channel? BJU Int. 2001;87(9):861–865. doi:10.1046/j.1464-410x.2001.02208.x

32. Clark T, Pope JC, Adams MC, Wells N, Brock JW. Factors that influence outcomes of the Mitrofanoff and Malone antegrade continence enema reconstructive procedures in children. J Urol. 2002;168(4 Pt 1):1537–1540; discussion 1540. doi:10.1016/S0022-5347(05)64515-6

33. Kälble T, Roth S. Serosa-lined and tapered ileum as primary and secondary continence mechanism for various catheterizable pouches. J Urol. 2008;180(5):2053–2057. doi:10.1016/j.juro.2008.07.052

34. Figueroa TE, Sabogal L, Helal M, Lockhart JL. The tapered and reimplanted small bowel as a variation of the Mitrofanoff procedure: preliminary results. J Urol. 1994;152(1):73–75. doi:10.1016/s0022-5347(17)32820-3

35. Touma NJ, Horovitz D, Shetty A, et al. Outcomes and quality of life of adults undergoing continent catheterizable vesicostomy for neurogenic bladder. Urology. 2007;70(3):454–458. doi:10.1016/j.urology.2007.04.014