Umbilical Stoma Research Articles

Patent urachus with subcutaneous communication and ventral abdominal swelling in a domestic short‐hair cat

AbstractA 3‐month‐old, male, entire, domestic shorthair kitten underwent investigations for stranguria and haematuria, and was diagnosed with a urinary tract infection secondary to a suspected extramural vesicourachal diverticulum. Lower urinary tract signs resolved with a 14‐day course of amoxicillin clavulanate. Three months later, the kitten re‐presented for investigation of acute onset ventral abdominal discomfort and bruising. On presentation, clinical examination revealed omphalitis and subcutaneous bruising, with no evidence of an umbilical stoma. Ultrasonography demonstrated a patent urachus communicating with the subcutaneous tissue space, resulting in accumulation of urine at the level of the umbilicus. A ventral midline coeliotomy was performed to allow resection of the urachal remnant, including a partial cystectomy. The cat was urinating normally within 10 hours postoperatively, and the wound healed without complication. No postoperative complications or recurrent lower urinary tract signs were reported at follow‐up (312 days).

Quality of life amongst patients with diverting umbilical stomas in rectal surgery: a single centre prospective randomized controlled pilot study.

The umbilical stoma (umbistoma) has been proposed as a viable alternative site for a temporary defunctioning stoma. Suggested advantages of the umbistoma include decreased number of surgical incisions required, improved cosmesis and ease of reversal surgery. This study aimed to assess the patient experience of umbilical loop ileostomies in rectal surgery, with the primary outcome being patient reported quality of life (QoL). A total of 20 patients undergoing laparoscopic rectal cancer surgery were randomly allocated to have a defunctioning ileostomy at a conventional site (right iliac fossa) or at the umbilicus. Patient-reported QoL was assessed at 6 weeks using the Stoma-QoL questionnaire. Secondary outcomes were number of stomas reversed, length of time awaiting stoma reversal surgery, duration of operative time for stoma reversal, length of hospital stay following stoma reversal and rate of parastomal or post reversal incisional hernias. Patients who had an umbilical stoma scored significantly lower on the Stoma-QoL questionnaire compared to the conventional group, particularly on questions regarding feelings of tiredness, body insecurity and anxiety. No significant differences were observed between the two groups in relation to secondary outcomes. There may be potential disadvantages to the umbilical stoma with negative impacts on body image and subsequent increased social anxiety. Patient selection and adequate counselling will be important when considering an umbilical stoma. Further larger scale prospective studies are required to further validate the feasibility and longer-term safety of umbilical stomas in both clinical outcomes as well as patient QoL.

Quantitative evaluation of pediatric umbilical loop stomas: 2 decades of experience from a single institution

PurposeSince pediatric stomas are often temporary, their creation, management, and closure should be simple, with minimal complications and excellent cosmetic results. We began employing umbilical stomas in 2000. This study aimed to characterize the ingenuity and utility of umbilical stomas and provide a quantitative evaluation of their cosmetic outcomes.MethodsWe examined cases of stoma construction and closure surgery performed in our department from January 2000 to December 2022. The umbilical and non-umbilical stoma groups included 54 and 42 cases, respectively, and the findings for both groups were compared and analyzed.ResultsThe two groups showed no significant differences in the incidence of complications. The Manchester Scar Scale score for the umbilical stoma group (8.42 ± 1.85) was significantly better than that for the non-umbilical stoma group (16.31 ± 2.96; P < 0.01). Likewise, in Patient and Observer Scar Assessment Scale assessments, the umbilical stoma group showed significantly better scores in both the observer scale (9.48 ± 2.50 vs. 21.78 ± 7.26; P < 0.01) and the patient scale (10.5 ± 1.39 vs. 22.40 ± 7.35; P < 0.01).ConclusionsUmbilical stomas are easy to manage and yield an inconspicuous closure incision with excellent cosmetic outcomes. Although patient selection is important, pediatric umbilical stomas are a valuable option that can be actively employed.

Single Center Experience with Umbilical Stomas Following Colorectal Surgery.

Background: The umbilicus is commonly used as an access site to perform minimally invasive colorectal surgery. Umbilical stomas are becoming an attractive option as an alternative site for temporary stomas since they reduce the need for additional abdominal incisions. Methods: We retrospectively evaluated patients who underwent umbilical stoma creation after colorectal resection for diagnosis of rectal cancer, diverticulitis, or ulcerative colitis between January 2020 and July 2021. Surgical technique, clinical and perioperative outcomes, complications, and cosmetic end results were described. Results: A total of 11 patients underwent umbilical stoma creation. There were no major surgical complications. Peristomal skin irritation was secondary to difficulties with the management of the pouching system. One patient presented with ostomy prolapse. Three patients experienced incisional hernia after stoma reversal. There were no wound infections. Conclusion: Umbilical stomas appear to be a safe alternative to conventional stomas and provide superior cosmetic outcomes.

Pediatric laparoscopic mitrofanoff procedure- preliminary results of a simplified technique

Laparoscopic appendicovesicostomy (LA) is a rather new technique and still a challenging procedure even for the most experienced surgeons because it requires advanced laparoscopic experience and surgical skill. The aim of this study is to analyze the short-term results and benefits of laparoscopic LA in children. Prospective study of children undergoing LA at our institution between January 2018 and October 2021. The procedure was perfomed using a laparoscopic transperitoneal approach. The distal end of the appendix was spatulated and reimplanted in the bladder by a modified Shanfield technique. The proximal end was brought out as the cutaneous umbilical stoma. Over the study period 15 patients underwent LA (14 males,1 female). Mean age at intervention was 8.8 years (SD:3.1). Indication for surgery was pain during CIC in 13 (86.7%) and difficulty for CIC in 2 (13.3%). Eight patients (53.5%) presented end-stage renal disease (ESRD). Median operative time was 217.3min (r:140-300). Two patients (13.3%) experienced early postoperative complications: ileus (1) and internal hernia over the mesoappendix with subsequent intestinal obstruction. Mean hospital stay was 6.8 days (SD:1.7). Four patients (26.7%) experienced late postoperative stoma related complications: stomal stenosis (1), granuloma (1) and inability to catheterize (2). With a mean follow-up of 21.46 months (SD: 13) all except the patent who lost the conduit are continent and on CIC every 3h. We suggest that LA by this technique is effective, safe and reproducible, and is associated with good short-term results. The complication rate is similar to the open procedure being intestinal obstruction due to internal hernia probably the most serious.

Single Umbilical Stoma for Bilateral Ureterostomy after Radical Cystectomy.

Cutaneous ureterostomy after radical cystectomy is less preferred compared with other permanent urinary diversions due to bilateral stomas. Single umbilical stoma for bilateral ureterostomy (SUSBU) may be a choice, in this study we reviewed the outcomes of SUSBU in seventeen patients who underwent radical cystectomy. This was a case-series study conducted from April 2016 to Dec 2017. Seventeen male patients with confirmed PT2 bladder urothelial carcinoma who were not suitable for performing conduit or orthotopic urinary diversion, including those with high-risk patients underwent single umbilical stoma for bilateral ureterostomy after radical cystectomy. All patients were prospectively followed up for 24 months ± 2 months, this study was done in a teaching center mainly by senior residents. The mean age of patients was 68.6 ± 6.41 years. The mean length of operation time was 176.7 ± 15.1 minutes (from intubation to extubation from anesthesia). Sixteen patients were diagnosed with PT2 and one patient had a PT4 diagnosis. The decrease in hemoglobin level after surgery was 1.72 mg/dl ± 0.35 and creatinine increased by 0.15 ± 0.05 mg/dl. None of our patients had oliguria. One case developed constipation and no gas passing, with the suspicion of obstruction, underwent abdominal exploration, however, no obstruction or urine leakage was found and the patient was treated conservatively. One patient developed a fever during admission, in which atelectasis was identified as the cause. One patient underwent a second operation because of fascia dehiscence. It seems that this technique is suitable for high-risk patients with acceptable operating time, surgical complications, and fast recovery after the operation and one ureterostomy bag instead of two one's comparing to bilateral cutaneous ureterostomy.

Split appendix catheterizable urinary channels are at no higher risk of undergoing revision compared to channels made with the intact appendix

To assess long-term APV and split-appendix MACE durability and to compare split and intact appendix APVs in a large patient cohort. This retrospective cohort study included consecutive patients ≤21 years old undergoing an APV at our institution (1990-2019). Main outcomes were stomal and subfascial revisions. Kaplan Meier survival and Cox proportional hazards analysis were used. A total of 339 patients underwent APV creation at a median 7.4 years old (41% female vs. 59% male; 37% umbilical stoma vs. 63% other). In total, 36 patients underwent a stomal revision and 19 a subfascial revision (median channel follow-up 6.3 years). On survival analysis, the risk of stomal revision of the APV was 9.1% at 5 years, 12.6% at 10 years and 16.5% at 15 years. Risk of subfascial revision of the APV was 5.1% at 5 years, 7.0% at 10 years and 8.2% at 15 years. A split-appendix APV was performed in 118 (34.8%) of 339 patients. They had a shorter follow-up compared to those with an intact APV (5.1 vs. 7.0 years, p=0.03). After correcting for differential follow-up time, there was no significant difference between groups for stomal revisions (HR 1.11, p=0.76) or subfascial revisions (HR 0.80, p=0.67, Figure). Risk of APV stomal revision was independent of stomal location and age at surgery (p≥0.37). Similarly, risk of subfascial APV revision was independent of stomal location and age at surgery (p≥0.18). Risk of stomal revision for split-appendix MACE channels was 16.2% at 5, 10 and 15 years (similar to split-appendix APV and all APVs, p≥0.26). Risk of MACE subfascial revision was 5.5% at 5 years, 5.5% at 10 years and 14.7% at 15 years (similar to split-appendix APV and all APVs, p≥0.36). We focused on surgical complications, as these entail the highest morbidity, however, we did not assess non-surgical, percutaneous or endoscopic management which also impact long-term outcome and patient quality of life. We did not compare the outcomes of the split-appendix MACE to an intact-appendix MACE cohort, as this patient population was not captured in this review. The split-appendix technique has durable long-term results for both the APV and MACE channels, which are comparable to the technique utilizing the intact appendix. Channel complications occur over the channel's lifetime, as 1 in 8 APVs in the entire cohort underwent a stomal revision and 1 in 14 APVs underwent a subfascial revision at 10 years after surgery.

P0360 - Right iliac fossa or umbilical stoma for a mitrofanoff – which is the best site?

P0360 - Right iliac fossa or umbilical stoma for a mitrofanoff – which is the best site?

Totally robotic intracorporeal Monti-Yang continent ileovesicostomy in patient with previous robotic surgery–Technique description

We present a video case report of a pediatric patient with previous robotic abdominal surgery who underwent robotic assisted Monti-Yang continent ileovesicostomy. This 10-year-old female had a history of spina bifida, with previous myelomeningocele repair and ventriculoperitoneal shunt as an infant and robotic-assisted Malone procedure and artificial urethral sphincter placed 4 years ago. After undergoing bilateral hip surgery, she presented with difficult urethral catheterization due to reduced leg mobility. A Monti-Yang ileovesicostomy procedure was planned. A 5mm laparoscopic port placed through the umbilicus followed by four additional DaVinci XI working ports. Twenty centimeters proximal the ileocecal valve, a 3cm segment of ileum was dissected, then transected, detubularized, and retubularized around a 10 Fr catheter. This conduit was reimplanted to the anterior bladder wall. The other edge was fixed to the umbilicus. A 10 Fr Foley catheter was left clamped in the conduit, and a urethral Foley was left to gravity. Total operative time was 3h 56min. The patient did well post-operatively. She was discharged home on POD 6. Starting three weeks after surgery, the patient began catheterizing through the umbilical stoma. At 3 month follow-up, the patient catheterizes through her stoma every 3h without leakage between catheterizations.

Preliminary experience with umbilical stoma in transumbilical single-port colorectal surgery.

The umbilicus, an embryological natural orifice, is increasingly used as the only access route during single-incision laparoscopic surgery (SILS) for colorectal disease. As a part of some of these procedures, a temporary, diverting ostomy could be exteriorized through the umbilicus itself. Theoretical advantages include better preservation of the abdominal wall and potentially superior cosmetic results. The aim of the present study was to evaluate our preliminary experience in SILS colorectal resection with umbilical stoma (u-stoma). We retrospectively reviewed all colorectal patients operated using SILS for benign or malignant disease at Paris Poissy Medical Center. Patients were selected for consideration of u-stoma with our stoma therapists. Between January 2010 and December 2016, 234 patients underwent colorectal SILS procedures. In 74 patients (31.6%), an ileostomy (n=41) or a colostomy (n=33) was fashioned. Of these, 20 (27% of all ostomies) were umbilical stomas. The 20 u-stoma patients, 10 men and 10 women, received either a loop ileostomy (n=14) or an end (n=4) or loop (n=2) colostomy. The mean age was 52years (range 29-81years). There was no mortality. Operative stoma-related morbidity occurred in only 5% of patients (n=1: ileal torsion volvulus). Median follow-up after stoma formation was 30months (range 12-59months). Adjustment to the stoma and quality of life were satisfactory as estimated by both the patient and the stoma therapist. All stomas were reversed. At a median follow-up of 27.5months (range 7-55months) after stoma reversal, two patients had reoperation for incisional hernia. This preliminary experience showed that u-stoma is a feasible and safe alternative to more conventional ostomy after SILS.

Purse-String Skin Closure for Umbilical Stoma Caused by Omphalocele With Kagami-Ogata Syndrome: A Case Report

Purse-String Skin Closure for Umbilical Stoma Caused by Omphalocele With Kagami-Ogata Syndrome: A Case Report

Technique of Suprafascial Anastomosis With Reduced Risk of Stenosis of the Efferent Outlet in Continent Catheterizable Urinary Diversion

To describe our technique and long-term experience with a technique of a suprafascial anastomosis for the efferent continent segment in continent cutaneous urinary diversion, which aims to reduce the rate of stomal strictures. Between 1998 and 2013, up to 191 patients underwent continent cutaneous urinary diversion with a suprafascial anastomosis technique at our institution. A complete follow-up was achievable in 82 patients. The retrospective analysis included continence rates, stomal complications, and other complications related to the urinary diversion such as anastomotic insufficiencies, fistulas, or hernias. The study population consisted of 82 patients with 67 (82%) women and 15 (18%) men with a median age of 58 years. The median length of follow-up was 82 months (range 13-203) with a median survival time of 46 (range 13-193) months. At the time of the analysis, 46 patients (57%) were still alive. Five out of 82 patients (6%) presented with a relevant stenosis in umbilical stoma that required surgical revisions. Nine patients (12%) with functional stenosis could be treated conservatively. Continence was achieved in 74 of 82 patients (90%). Only 8 patients reported some degree of incontinence. The technique of a suprafascial stoma is a simple and safe technique that may help prevent the incidence of stomal complications.

Feasibility of umbilical loop ileostomy in overweight and obese patients with rectal cancer during laparoscopic surgery: Preliminary results.

We examined the feasibility of umbilical diverting ileostomy for overweight and obese patients with rectal cancer undergoing laparoscopic surgery. Four patients who were overweight or obese (BMI > 27 kg/m2 ) were initially scheduled for the creation of a conventional loop ileostomy. Intraoperatively, however, this was considered too complicated because of thick subcutaneous fat, bulky mesentery, or both. Instead, patients received a diverting ileostomy with the placement of an umbilical stoma. All patients had protruding umbilical ileostomies. No severe stoma-related complications were encountered. One patient had minor skin dehiscence, and another had paralytic ileus but resumed oral intake after a short time. Performing a temporary loop ileostomy at the umbilicus was safe and feasible in this small group of overweight and obese patients. This stoma placement may avoid the problems inherent to conventional loop ileostomy in obese subjects.

Umbilical Stoma: A Classical but New Concept

Today, surgeons almost always create a stoma through a left or right rectus muscle-splitting incision to avoid placement at the midline laparotomy wound of patients. In the past, some surgeons preferred to create a colostomy in the umbilicus, but the practice did not gain general acceptance and the umbilicus had been regarded as a site to avoid for stoma creation. However, this attitude has recently changed in the field of pediatric surgery and adult laparoscopic surgery. The umbilical site has been used for temporary colostomies for neonates or infants with anorectal malformation or Hirschsprung’s disease. Further, umbilical diverting loop ileostomies have been developed to prevent leakage in adult patients undergoing laparoscopic colorectal surgery, whose umbilicus had already been open at the time of the bowel extraction. These reports indicate the umbilical stoma is feasible, safe and cosmetically superior when reversed. Here we review the history of stoma creation and recent utilization of the umbilical stoma and provide a brief discussion on future perspectives.

V7-06 PEDIATRIC ROBOTIC-ASSISTED LAPAROSCOPIC APPENDICOVESICOSTOMY REVISION

You have accessJournal of UrologyPediatrics1 Apr 2016V7-06 PEDIATRIC ROBOTIC-ASSISTED LAPAROSCOPIC APPENDICOVESICOSTOMY REVISION David M. Hatcher, Joseph J. Pariser, and Mohan S. Gundeti David M. HatcherDavid M. Hatcher More articles by this author , Joseph J. PariserJoseph J. Pariser More articles by this author , and Mohan S. GundetiMohan S. Gundeti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.563AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic surgery for reconstructive pediatric urology is an emerging technique, and robotic-assisted Mitrofanoff appendicovesicostomy is associated with relatively high stomal continence rates. However, some children experience incontinence, which may be related to inadequate support and resistance at the anastomosis of the appendix to the bladder. While endoscopic injection is often recommended first, some patients require surgical revision. We demonstrate our approach to surgical revision of a Mitrofanoff appendicovesicostomy in a pediatric patient. METHODS A 14 year old wheelchair bound male (BMI 42) with muscular dystrophy who previously underwent a robotic-assisted laparoscopic appendicovesicostomy creation experienced stomal incontinence at low volumes. Urodynamics demonstrated stomal incontinence at 175mL at low pressures without detrusor instability. Bulking agent injection was attempted first without relief. He was scheduled to undergo robotic revision. He was placed in semi-lithotomy position with minimal Trendelenburg. A 12mm camera port was placed superior and lateral to the umbilicus, given the umbilical stoma. Additionally, two 8mm robotic ports and a 5mm assistant port were placed. Great care was used to avoid disruption of the mesentery to the appendix and umbilical stoma. The appendix and a portion of the bladder was dissected from the anterior abdominal wall. The bladder, which was floppy, was wrapped around the proximal appendiceal channel and secured in place using 2-0 vicryl interrupted sutures without disrupting the previous anastomosis. RESULTS A 3cm bladder wrap was created around the proximal appendiceal channel. After completion of a successful wrap, continence was confirmed with 250mL of fluid. Operative time was 128 min. Estimated blood loss was 20mL. The patient was discharged on postoperative day 1, and a catheter was left in the Mitrofanoff for 20 days. At one month, continence was maintained. He awaits additional follow-up. CONCLUSIONS Stomal incontinence can occur after Mitrofanoff appendicovesicostomy. After failed endoscopic injection, a robotic approach represents a minimally invasive alternative to open revision. A bladder wrap offers additional support to the junction of the appendix to the bladder, which improves continence. Longer follow-up is needed to determine a durable outcome. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e724 Advertisement Copyright & Permissions© 2016MetricsAuthor Information David M. Hatcher More articles by this author Joseph J. Pariser More articles by this author Mohan S. Gundeti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical benefits of tubeless umbilical cutaneous ureterostomy.

We assess a novel technique of tubeless bilateral cutaneous ureterostomy, with a single umbilical stoma, for bladder cancer patients with short ureters after cystectomy. The benefit of cutaneous ureterostomy is equal to other incontinent urinary diversions, when the tubeless procedure is successfully achieved. This simple technique makes it easy to monitor the upper urinary tract (UUT) and is beneficial to patients with a high risk of UUT recurrence. This old and new surgical technique was used to perform total cystectomy and urinary diversion on three patients with bladder cancer at a high risk of UUT recurrence. Two men and one woman (mean age: 73 years) underwent this surgery and the mean follow-up period was 8.3 years. The surgical approaches were laparotomy (n = 2) and laparoscopy (n = 1). One case developed para-stomal erosion, whereas another developed ureteral stenosis requiring catheter reinsertion. Although postoperative hydronephrosis was observed in all cases, the mean preoperative and postoperative serum creatinine levels were 0.70 and 0.76, respectively. UUT recurrence was not observed during the follow-up period. This tubeless umbilical cutaneous ureterostomy procedure greatly improves the outcome of urinary diversion for cancer patients with short ureters at a high risk of UUT recurrence. The benefits are equivalent to other urinary diversions when the tubeless procedure is successfully achieved.

Laparoscopic Mitrofanoff procedure in children: Critical analysis of difficulties and benefits

The Mitrofanoff principle is an accepted continent urinary diversion. We studied the feasibility and the possible benefits of using a laparoscopic approach in children with significant bladder dysfunction associated with difficulty doing efficient urethral catheterization. A fully laparoscopic Mitrofanoff continent cystostomy was attempted in 15 children with a median age of 9 years (IQR 6), between 2003 and 2013. Before the Mitrofanoff procedure was considered, urodynamic evaluation was done for each patient, to study bladder compliance, detrusor activity, and bladder capacity. The procedure was performed using a transperitoneal four-port approach. A 30-degree down camera angle was optimal for viewing the appendix and the posterior wall of the bladder. The operative steps of the open procedure were replicated laparoscopically. The proximal end of the appendix was spatulated and anastomosed to the posterior wall of the bladder, providing an antireflux mechanism by an extramucosal tunnel. The distal end of the appendix was brought out as the cutaneous umbilical stoma. Some modifications were done because of the high rate of conversion due to early opening of the mucosa (harmonic hook) or difficult anastomosis: (a) use of 5-mm trocars to change the laparoscope position from the left to right subcostal area to better visualize the anastomosis, (b) the anastomosis was suspended at its two ends during suturing; a trans-abdominal traction suture of the bladder was inserted for better exposure of the anastomosis (hitch stitch) and to stabilize the anastomotic line during suturing, (c) use of a monopolar hook to cut the detrusor muscle fibers, to avoid incidental opening of the mucosa, and (d) the window between the appendix and the peritoneum was closed to avoid internal hernia. The procedure was totally completed by laparoscopy in 12 cases. Three were converted to an open procedure due to tearing of bladder mucosa (n = 2) or appendix ischemia (n = 1). Median operative time for fully laparoscopic Mitrofanoff was 255 min (IQR 52). Median follow-up was 18 months (IQR 35). No patient required stomal revision. Seven patients were continent, five experienced urinary leakage from urethra n = 1 and/or stoma n = 5. Three patients with stomal urinary leakage were successfully managed by Deflux (dextranomer-based implants) injection in the catheterizable channel. Two patients required an open revision of the appendicovesical anastomosis. The patient with both stomal and urethral urinary leakage also required the implantation of an artificial urinary sphincter 1.5 years after Mitrofanoff. One patient had bladder augmentation. Although our results of laparoscopic Mitrofanoff procedure in children are unsatisfying in cases of high-pressure bladders in terms of incontinent stoma, we still believe that it is justified to develop this challenging technique with more refinement and improvement, to provide a minimal invasive procedure that may postpone or even avoid bladder augmentation in pediatric age.

Management of Bleeding-associated Severe Gastritis of the Gastric Mucosa in a Patient With a Gastrocystoplasty

Gastrocystoplasty is a form of bladder augmentation (neobladder), where a segment of the stomach is surgically attached to the urinary bladder to increase bladder capacity and compliance. Although bleeding and malignant complications of gastrocystoplasty have been reported, the risks of these complications in the setting of gastrocystoplasty are not known. We describe the case of a 58-year-old African American woman with a history of a congenital solitary kidney, chronic kidney disease, and status postgastrocystoplasty and catheterizable umbilical stoma 21 years ago for neurogenic bladder presented with gross hematuria. To the best of our knowledge, this is the first reported case of gastrocystoplasty with a bleeding complication that has endoscopic pictures before and after treatment with proton pump inhibitor.

ストーマ造設が必要な臍帯内ヘルニアに臍部ストーマ造設後，3 枚皮弁による臍形成術を行った1 例

ストーマ造設が必要な臍帯内ヘルニアに臍部ストーマ造設後，3 枚皮弁による臍形成術を行った1 例

Monti as continent catheterized stoma using serosal-lined trough "Ghoneim Abolenin" technique in ileocystoplasty

It is a great challenge to select and perform continent mechanism in a stoma for urinary reservoir. A new technique by combining MONTI ileal conduit with the serosal lined trough in order to achieve continent catheterizable stoma to the umbilicus as a part of augmentation ileocystoplasty. We applied serosal-lined trough as a continent mechanism with MONTI ileal tube in 12 years smart girl underwent ileocystoplasty for neuropathic bladder due to meylomeningocele in whom continence failed to be achieved by using Mitrofanoff with submucosal tunnel of the bladder as continent mechanism before, also the previous operation included left to right transuretero-ureterostomy, ureterocystoplasty and reimplantation of the right ureter. The patient became completely continent; she was able to do self-catheterization easily through the umbilical stoma using 16-French catheter and was able to wash the mucous easily. The capacity of the augmented bladder was 300ccs. She became independent from her mother and stopped using diapers, anticholinergic and antibiotics. Combining MONTI conduit with serosal-lined extramural valve trough (The Ghoneim technique) is an effective continent technique and gives wider channel for catheterization and washing out the mucous.