Abstract
Purpose: We present our long-term followup and comparison of outcomes between the Monti and Casale (spiral Monti) procedures in a large group of children and young adults. Materials and Methods: A retrospective chart review was done, including all patients undergoing the Monti or Casale procedure at our institution with a minimum followup of 6 months. Age at surgery, the bowel segment used, stomal location, the number and type of revisions or endoscopic procedures required after channel creation, problems catheterizing and channel continence were documented, and a database was created. Results: Of 188 patients identified with at least 6 months of followup 109 underwent a Monti procedure, while 79 underwent a Casale procedure. Patient age at surgery was 10 months to 31 years (mean 10.2 years). Mean followup was 43 months for the entire cohort, and 47.2 and 37.2 months for the Monti and Casale groups, respectively. A total of 43 open revisions were required in 36 patients (19.1%). Stomal revisions accounted for 18 procedures, while subfascial revisions accounted for 25 in 17 (9.0%) and 21 (11.2%) patients, respectively. A total of 21 endoscopic procedures requiring anesthesia were performed in 17 patients (9.0%). In the Monti group stomal revision was required in 11 patients (10.1%), while subfascial revisions were required in 9 (8.3%). In the Casale group stomal revision was required in 6 patients (7.6%), while subfascial revisions were required in 12 (15.2%). Of the channels 98% were completely continent at the stoma. Conclusions: In a large population of children and young adults we report durable and reliable long-term results with the Monti and Casale procedures, including continence at the stoma. The only significant difference noted between the 2 procedures was a higher incidence of subfascial revisions for umbilical stomas in each group. The need for subfascial revision is highest in spiral Monti channels placed in the umbilicus.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1623-1627 |
| Number of pages | 5 |
| Journal | Journal of Urology |
| Volume | 178 |
| Issue number | 4 SUPPLEMENT |
| DOIs | |
| State | Published - Oct 2007 |
| Externally published | Yes |
Fingerprint
Keywords
- appendix
- stomas
- urinary bladder, neurogenic
- urinary catheterization
- urinary diversion
ASJC Scopus subject areas
- Urology
Cite this
A Comparison of the Monti and Casale (Spiral Monti) Procedures. / Leslie, Jeffrey A.; Cain, Mark P.; Kaefer, Martin; Meldrum, Kirstan K.; Dussinger, Andrew M.; Rink, Richard C.; Casale, Anthony J.
In: Journal of Urology, Vol. 178, No. 4 SUPPLEMENT, 10.2007, p. 1623-1627.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A Comparison of the Monti and Casale (Spiral Monti) Procedures
AU - Leslie, Jeffrey A.
AU - Cain, Mark P.
AU - Kaefer, Martin
AU - Meldrum, Kirstan K.
AU - Dussinger, Andrew M.
AU - Rink, Richard C.
AU - Casale, Anthony J.
PY - 2007/10
Y1 - 2007/10
N2 - Purpose: We present our long-term followup and comparison of outcomes between the Monti and Casale (spiral Monti) procedures in a large group of children and young adults. Materials and Methods: A retrospective chart review was done, including all patients undergoing the Monti or Casale procedure at our institution with a minimum followup of 6 months. Age at surgery, the bowel segment used, stomal location, the number and type of revisions or endoscopic procedures required after channel creation, problems catheterizing and channel continence were documented, and a database was created. Results: Of 188 patients identified with at least 6 months of followup 109 underwent a Monti procedure, while 79 underwent a Casale procedure. Patient age at surgery was 10 months to 31 years (mean 10.2 years). Mean followup was 43 months for the entire cohort, and 47.2 and 37.2 months for the Monti and Casale groups, respectively. A total of 43 open revisions were required in 36 patients (19.1%). Stomal revisions accounted for 18 procedures, while subfascial revisions accounted for 25 in 17 (9.0%) and 21 (11.2%) patients, respectively. A total of 21 endoscopic procedures requiring anesthesia were performed in 17 patients (9.0%). In the Monti group stomal revision was required in 11 patients (10.1%), while subfascial revisions were required in 9 (8.3%). In the Casale group stomal revision was required in 6 patients (7.6%), while subfascial revisions were required in 12 (15.2%). Of the channels 98% were completely continent at the stoma. Conclusions: In a large population of children and young adults we report durable and reliable long-term results with the Monti and Casale procedures, including continence at the stoma. The only significant difference noted between the 2 procedures was a higher incidence of subfascial revisions for umbilical stomas in each group. The need for subfascial revision is highest in spiral Monti channels placed in the umbilicus.
AB - Purpose: We present our long-term followup and comparison of outcomes between the Monti and Casale (spiral Monti) procedures in a large group of children and young adults. Materials and Methods: A retrospective chart review was done, including all patients undergoing the Monti or Casale procedure at our institution with a minimum followup of 6 months. Age at surgery, the bowel segment used, stomal location, the number and type of revisions or endoscopic procedures required after channel creation, problems catheterizing and channel continence were documented, and a database was created. Results: Of 188 patients identified with at least 6 months of followup 109 underwent a Monti procedure, while 79 underwent a Casale procedure. Patient age at surgery was 10 months to 31 years (mean 10.2 years). Mean followup was 43 months for the entire cohort, and 47.2 and 37.2 months for the Monti and Casale groups, respectively. A total of 43 open revisions were required in 36 patients (19.1%). Stomal revisions accounted for 18 procedures, while subfascial revisions accounted for 25 in 17 (9.0%) and 21 (11.2%) patients, respectively. A total of 21 endoscopic procedures requiring anesthesia were performed in 17 patients (9.0%). In the Monti group stomal revision was required in 11 patients (10.1%), while subfascial revisions were required in 9 (8.3%). In the Casale group stomal revision was required in 6 patients (7.6%), while subfascial revisions were required in 12 (15.2%). Of the channels 98% were completely continent at the stoma. Conclusions: In a large population of children and young adults we report durable and reliable long-term results with the Monti and Casale procedures, including continence at the stoma. The only significant difference noted between the 2 procedures was a higher incidence of subfascial revisions for umbilical stomas in each group. The need for subfascial revision is highest in spiral Monti channels placed in the umbilicus.
KW - appendix
KW - stomas
KW - urinary bladder, neurogenic
KW - urinary catheterization
KW - urinary diversion
UR - http://www.scopus.com/inward/record.url?scp=34548424979&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34548424979&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2007.03.168
DO - 10.1016/j.juro.2007.03.168
M3 - Article
VL - 178
SP - 1623
EP - 1627
JO - Journal of Urology
JF - Journal of Urology
SN - 0022-5347
IS - 4 SUPPLEMENT
ER -