title: 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.
abstract: OBJECTIVE
  To present our simplified technical modification of double-T continent cutaneous diversion (CCD) using Yang-Monti tubes.
  
  
  METHODS
  During 2008-2011, 8 adult patients underwent CCD; 4 had classical exstrophy, 2 bladder cancer, 1 recurrent vaginal cancer post-radiotherapy, and 1 prostate cancer with post-simple retropubic prostatectomy urethral stricture with incontinence. For reconstruction, a 45- to 50-cm segment of terminal ileum sparing 25 cm of terminal ileum was harvested. Its distal 3- to 6-cm and proximal 3-cm segments were separated on vascular pedicle and fashioned into Yang-Monti tubes (1 proximally and 1 or 2 distally). The middle 40- to 45-cm detubularized segment was fashioned into a "W" shape, and serosal aspects of adjacent loops were sutured together close to the mesentery. The tubes were implanted into the W pouch via extramural serosa-lined tunnel (Abol-Enein and Ghoneim). The pouch was closed transversely over an 18-Fr pouchostomy and 16-Fr stomal catheter. The ureters were implanted into the proximal tube using the Wallace principle, over 6- to 8-Fr infant feeding tubes exteriorized through the pouch. The distal end of the distal tube was made into a flush stoma.
  
  
  RESULTS
  In the early postoperative period, intestinal obstruction (2 cases), ureteroileal anastomotic leakage (3 cases) and vesico-ileocutaneous fistula (1 case) were encountered. No ureteroileal anastomotic obstruction or catherization-related difficulty was observed until the last follow-up (2 months to 3 years). Of 15 anastomoses, 14 were nonrefluxing.
  
  
  CONCLUSIONS
  Ileal double-T CCD using the Yang-Monti principle is technically feasible and relatively simple, particularly in nonirradiated ileum. However, early complications indicate a learning curve, and long-term follow-up and larger data are needed.
authors.affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. drmayank.22@gmail.com
authors.forename: Mayank Mohan
authors.initials: MM
authors.lastname: Agarwal
authors.forename: Ravimohan
authors.initials: R
authors.lastname: Mavuduru
authors.forename: Shrawan K
authors.initials: SK
authors.lastname: Singh
authors.forename: Arup K
authors.initials: AK
authors.lastname: Mandal
mesh_terms: D000328:Adult; D000368:Aged; D001746:Bladder Exstrophy / Q000601:surgery; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014525:Urethral Stricture / Q000601:surgery; D001745:Urinary Bladder Diseases / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D055815:Young Adult