Yang-Monti catheterizable channel is a continent urinary diversion technique described as an effective treatment option in neurogenic lower urinary tract dysfunction (NLUTD) patients unable to perform clean intermittent catheterization (CIC) through the urethra. Due to its significant complication rates and due to being an invasive procedure, it is rarely a first line treatment of choice.  So far, isolated cases or short series of laparoscopic and robotic techniques have been published, most of them in children. The advantages of performing this minimally procedure include decreased intraoperative bleeding, postoperative pain, quicker recovery with shorter hospitalization length and better cosmetic results. The objective of this work is to describe the technique of laparoscopic Yang-Monti continent derivation in adults with NLUTD.

We present a case of a 50 years-old female with history of acute coronary syndrome and subsequent T4 medullary ischemia in 2021. Spinal cord injury resulted in paraplegia and an underactive bladder with the need of CIC 4 times per day. A derivation colostomy was performed due to the arise of sacral pressure ulcer. Urodynamics showed a cystometric capacity over 500ml, normal compliance, absent bladder sensitivity and an acontractile detrusor. She had difficulty in transfer and poor autonomy. Therefore, in 2023, she was proposed for a laparoscopic Yang-Monti catheterizable channel. She had been previously submitted to an appendicectomy, being thus excluded the possibility of performing a Mitroffanof diversion.

The patient was positioned in lithotomy and a bladder catheter was introduced. Pneumoperitoneum was accomplished with Veress needle in Palmer’s point due possible abdominal adhesions from previous abdominal surgeries. Five ports were placed: one 11mm 2-5cm above the umbilicus for the camera, another 11mm half-way between the umbilicus and the pubic symphysis, and further 3 ports of 5mm, two medial to the left and right anterior superior iliac spines and one in right pararectal line. Initially, bladder dissection is performed to achieve maximum mobility. Three stay sutures were percutaneously placed on the bladder dome to accomplish its suspension and a good exposition of the posterior aspect of the bladder. Ileum was inspected and adequate mesentery length was assured. The most mobile segment was marked with a suture. A 5cm midline vertical detrusor incision is made posteriorly until the mucosa is visualized. The bladder mucosa is then opened approximately 1 cm in length. An arciform infraumbilical incision allows the exteriorization and subsequent section of the 4cm previously marked ileum segment. The distal 20cm of terminal ileum were properly preserved. An end-to-end ileal anastomosis was performed with running 3/0 absorbable suture. The ileal segment was detubularized and after retubularized and calibrated over a 12Ch vesical catheter. The catheter was fixed to the conduit with a resorbable suture, to avoid accidental displacement. An intracorporeal ileovesical anastomosis is then undertaken with a 3/0 barbed suture, followed by 3 interrupted absorbable monofilament stiches to create a Lich Gregoir anti-reflux subserous tunnel. Finally, the conduct was exteriorized through an umbilical port and a catheterizable stoma was created. The operative time was 150 minutes and reported blood loss was less than 50cc.  The patient was discharged after 5 days. The stoma catheter was left indwelling for 3 weeks and a cystogram was performed at removal. No urinary leakage was shown. So far, the patient is very satisfied, with increased autonomy and ease of self-catheterization without incontinence.

Laparoscopic Yang-Monti continent derivation is a challenging, yet feasible and safe procedure in the adult population. This procedure offers a significant increase in autonomy, further protection of the upper urinary tract with high satisfaction rates, reduced hospitalization, peri-operative pain and good cosmetic results.

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