Background:
Obstetric fistula with total destruction of the bladder neck and urethra remains a devastating condition in many parts of the world, particularly sub-Saharan Africa. In such cases, standard fistula repair is impossible, and continent urinary diversion becomes the only viable option to restore continence and dignity. However, existing techniques often involve complex ureteric reimplantation, external stomas, and long-term metabolic risks—making them impractical in low-resource settings.

Objective:
To describe and evaluate a novel continent urinary diversion technique using a J-shaped ileal neobladder with a catheterisable umbilical stoma, adapted specifically for use in women with complex vesicourethral injury in resource-limited environments.

Methods:
A retrospective analysis was conducted on twelve patients who underwent the procedure between 2018 and 2023. The technique involves constructing a low-pressure ileal reservoir without complete cystectomy or ureteric reimplantation. One limb of the ileal J-pouch is tapered to form a catheterisable channel, which is tunnelled through the rectus abdominis and externalised at the umbilicus. The stoma allows clean intermittent catheterisation (CIC) using standard urinary or nasogastric catheters. Patients were followed clinically and remotely via mobile phone for continence status, complications, and satisfaction.

Results:
All 12 patients were female (mean age: 31 years). Eleven had previously failed multiple fistula repair attempts; one had congenital bladder agenesis. Median follow-up was 24 months. Continence was achieved in all patients. No cases of stoma necrosis, channel stenosis, or reservoir obstruction were observed. One patient was lost to follow-up. Patients performed CIC independently 4–5 times daily and managed daily bladder irrigation without specialised equipment. In all cases, catheters remained functional for up to 3 months without replacement or infection. Satisfaction surveys demonstrated excellent psychosocial and functional outcomes, with discreet umbilical placement rated highly.

Conclusions:
This continent diversion technique provides a reproducible, safe, and cosmetically acceptable solution for patients with complex bladder and urethral injuries. Its low morbidity, preservation of native ureteric drainage, and compatibility with simple catheterisation tools make it especially suitable for low-resource settings. These findings contribute to ongoing global efforts to expand continence care solutions for neglected patient populations.

Keywords:
Obstetric fistula, continent diversion, ileal neobladder, low-resource surgery, umbilical stoma, clean intermittent catheterisation