Journal of Surgery 2013; 1(2): 22-27 Published online June 10, 2013 (http://www.sciencepublishinggroup.com/j/js) doi:10.11648/j.js.20130102.14 Continent urinary diversion with short appendices in obese patients: the initial results of a surgical option Marcelo Ferreira Cassini 1* ,Antônio Antunes Rodrigues Júnior 1 , Adauto José Cologna 1 , Alessandra Mazzo 2 , SílvioTucci Júnior 1 1 Division of Urology, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil 2 Faculty of Nursing, of Ribeirao Preto, University of Sao Paulo, Brazil Email address: marcelo.cassini@globo.com(M. F. Cassini), aantunesrj@yahoo.com.br(A. A. Rodrigues Jr.), ajcologn@fmrp.usp.br(A. J. Cologna),amazzo@eerp.usp.br(A. Mazzo), stucci49@gmail.com(S. Tucci Jr.) To cite this article: Marcelo Ferreira Cassini, Antônio Antunes Rodrigues Júnior, Adauto José Cologna, Alessandra Mazzo, SílvioTucci Júnior. Continent Urinary Diversion with Short Appendices in Obese Patients: the Initial Results of a Surgical Option. Journal of Surgery. Vol. 1, No. 2, 2013, pp. 22-27. doi:10.11648/j.js.20130102.14 Abstract: Introduction:Many patients needto be submitted to a continent urinary derivation surgery. Lost of bladder compliance secundary to neurogenic bladder injuries, severe and untractable urethral stenosis are some of the main indications.We present here the initial results and outcomes of twelve procedures performed using the association between Mitrofanoff’s principle and Monti’s technique as a surgical option for a continenturinarydiversion in patients with short appendices or obese.Materials and Methods:We analyzed data from twelve patients who were submitted to ileocistoplasty and urinary continent derivation by association between Mitrofanoff’s principle and Monti’s technique performed from january2009 to december 2012 in our institution.In all patients the appendices were too short to reach the skin, some of them, because the obesity.Results:Twelve patients were submitted to the Mitrofanoff and Monti techniques association. The most common surgical complications were stoma skin stenosis (02 cases) and urinary leakage through the re-opened bladder neck in 02 patients. Urinary infection (01 sepse) was the main clinical complication. Eleven patients are totally adapted to intermittent clear catheterization through the naveland satisfyed with urinary continence and quality of life.There were no deaths and no urinary or intestinal fistulas secondary to the procedure.Conclusions:The association between Mitrofanoff’s principle and Monti’s technique is safe, feasible and a very useful alternative in urologic cases, (i.e., severe and untractable urethral stenosis and low compliance neurogenic bladder, for example) of continent urinary diversion, when the ileocecal appendix is too short to reach the skin (i.e., obese patients). Keywords: Mitrofanoff, Principle, Monti, Technique, Bladder Augmentation, Urethral Stenosis, Continent Urinary Diversion 1. Introduction The management of neurogenic miccional dysfunction and urinary incontinence has been revolutionized by the introduction of clear intermittent catheterization (CIC) by Lapides in 1972 (1) , and later, by the description of the “trans-appendicular continent cystostomy” by Mitrofanoff in 1980 (2) . Mitrofanoff launched a new concept whereby the bladder could be emptied by a route other than the urethra. This concept led to the publication of many alternatives to the appendix conduit, including the transverse ileal (Yang- Monti) (3,4) tube, and conduits constructed from ureter, Fallopian tube, tabularized preputial transverse island flap, and longitudinally tabularized ileal and gastric segments. Further experience with the procedure, and the onset of complications such as stomal stenosis and leakage, instigated the description of various stomal options and conduit implantation techniques. More recently, laparoscopic and robotically assisted techniques have also been performed. (5) Hydronephrosis, reflux and renal failure are serious complications that occur in patients with neurogenic overactive bladder. Such patients should be treated starting in childhood with clean and intermittent catheterization along with anticholinergics in the presence of detrusor overactivity. In severe cases (i.e., sphincter dyssynergia), there are greater risks of renal failure (6) . When,irrespective of the treatment, the patient has an unsatisfactory outcome