Patients with neurogenic lower urinary tract dysfunction (NLUTD) may present with a combination of voiding dysfunction, urinary incontinence and inability to perform urethral clean intermittent catheterization (CIC), significantly impairing quality of life and increasing the risk of infectious and upper urinary tract complications. [1]
Urinary dysfunction is a well-recognized sequela after colorectal cancer treatment, particularly following rectal resection and pelvic radiotherapy, and has been shown to significantly impact quality of life. These effects are mainly attributed to pelvic autonomic nerve injury and radiation-induced fibrosis affecting lower urinary tract function. [2]
In complex cases, reconstructive surgery aimed at restoring continence and enabling catheterization may be required. A combined approach addressing both outlet resistance and catheterization access may provide functional independence and improve quality of life. [3]

We present a surgical video of a fully robotic procedure combining Mitrofanoff channel creation using the appendix and placement of an autologous fascia lata sling in a female patient with NLUTD and severe urinary incontinence.
Is a 66 years old female patient with history of colorectal cancer treated with low anterior resection followed by radiotherapy and chemotherapy, after which she developed neurogenic lower urinary tract dysfunction. She subsequently presented with urinary retention with overflow incontinence, requiring indwelling catheterization, and experienced recurrent urinary tract infections, including an episode of urosepsis.
Preoperative videourodynamics demonstrated absence of bladder sensation, acontractile detrusor, and neurogenic intrinsic sphincter deficiency, with continuous urinary leakage at high bladder volumes and inability to achieve voluntary voiding.
The video illustrates key steps including bladder preparation, appendiceal isolation and channel construction and detrusor tunneling. A detrusor tunnel is created to provide a flap-valve mechanism, ensuring continence of the catheterizable channel according to the Mitrofanoff principle. The bladder neck dissection, fascia lata harvesting and sling placement using robotic approach are also demonstrated, highlighting critical steps to optimize continence and channel function.

The procedure was successfully completed using a robotic approach without intraoperative complications. A well-vascularized catheterizable channel was created and a functional detrusor tunnel. An autologous fascia lata sling was placed using a robotic approach around the bladder neck in a circumferential fashion to provide appropriate outlet resistance.
The transurethral catheter was removed one week postoperatively, and the catheterizable channel stent was removed at three weeks. The patient initiated clean intermittent catheterization through the stoma every 3 hours.
At follow-up, the patient achieved complete urinary continence, with no episodes of urinary leakage or recurrent urinary tract infections. Functional outcomes were satisfactory, and no postoperative complications were observed.

A combined robotic approach for Mitrofanoff channel creation and autologous fascia lata sling placement is a feasible and effective option in selected patients with NLUTD, particularly in the presence of an acontractile bladder and intrinsic sphincter deficiency. This technique addresses both continence and catheterization challenges in a single procedure, potentially restoring autonomy and improving quality of life. Robotic assistance enables precise reconstruction in complex lower urinary tract surgery.

Bosch JLHR, Norton P, Jones JS. Should we screen for and treat lower urinary tract dysfunction after major pelvic surgery? Neurourol Urodyn. 2012;31:327–329.
Sinimäki S, Elfeki H, Kristensen MH, Laurberg S, Emmertsen KJ. Urinary dysfunction after colorectal cancer treatment and its impact on quality of life in women. Colorectal Dis. 2021;23:384–393.
Famakinwa O, Gundeti MS. Robotic assisted laparoscopic Mitrofanoff appendicovesicostomy (RALMA). Curr Urol Rep. 2013;14:41–45.

Continence 19S (2026) 102599
DOI: 10.1016/j.cont.2026.102599