Search

INTRODUCTION: The present study aimed to assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) in elderly patients. MATERIALS AND METHODS: We retrospectively reviewed 50 PCNLs performed in the elderly patients (age > 65 years) carried out in our clinic from 2001 through 2007 and compared those with 248 PCNLs performed in younger patients (age < 40 years) during the same period. RESULTS: No significant difference was seen in calculus burden between the two groups. The success rates (stone-free patients and patients with residual calculi < 4 mm) were 85% for the elderly patients and 90% for the younger patients (P = .45). The major composition of calculi was calcium oxalate in 58% and 66.5% of the elderly and younger groups, respectively. No significant complication was observed in the elderly group. Fever without sign and symptoms of bacteremia was seen in 3 patients of each group (8.0% versus 1.2%, P = .004). The operative time was 75.0 +/- 6.4 minutes and 76.0 +/- 5.1 minutes (P = .25), and the mean hospital stay was 3.7 +/- 0.3 days and 3.8 +/- 0.9 days (P = .80) in the elderly and younger patients, respectively. CONCLUSION: We found that PCNL in patients over 65 years was a safe and reliable technique with a stone-free rate of 85% for all types of calculi. Well-controlled comorbidities do not increase the risk of operation. It seems that despite the higher medical risk in the elderly patients, PCNL could be safe and yields a high stone-free rate. [ABSTRACT FROM AUTHOR]

Introduction: Radiofrequency (RF)-based stress urinary incontinence (SUI) treatment, which has quickly attracted attention, is administered in an office setting. This pilot-safety study assessed the efficacy of transvaginal RF treatment in the quality of life (QOL) and frequency of incontinence episodes in women with SUI. Methods: Twenty-eight women suffering from SUI were treated with an intravaginal quadric applicator while a grounding pad was attached in front of their pubes. The first phase is thermic, which will heat up the vaginal wall up to 40°C for 10 minutes. The second step is contraction to stimulate an aerobic exercise of pelvic floor muscles for 20 minutes (pulsed contractile RF at 20-40 watts and 1000-300 kHz with a modulation of 1 to 300 Hz for muscle exercise). It was scheduled for one session per week for 3 sessions. Patients had follow-up visits before and 1, 6 and 12 months following the treatment for one-day voiding diary, Persian version of urinary incontinence QOL questionnaire (I-QOL), Q-tip test, 24 hours-pad test and daily incontinence episodes' number. Results: The patients' mean age, duration of incontinence and median vesical leak point pressure were 41.6±9.6 years, 5.48±6.84 years and 140 cm H 2 O respectively. Significant changes were observed in the mean I-QOL total score and the pad test. Also, a notable reduction was observed in the number of daily leakage episodes and the Q-tip test at any follow-up visit ( P =0.001). Conclusion: Preliminary results suggest that transvaginal RF is a convenient method of SUI treatment. Significant changes were observed in the mean I-QOL total score and the pad test. Also, a notable reduction was observed in the number of daily leakage episodes., (Copyright © 2021 J Lasers Med Sci.)

Introduction: Although intravascular laser irradiation of blood (ILIB) is deemed an innocuous and useful technique for laser therapy, particularly when systemic effects are required, no study, to our knowledge, has been conducted on the effectiveness and innocuousness of ILIB in treating acute kidney injury (AKI). Objective: This study aimed to assess the feasibility and outcomes of ILIB in the management of patients with AKI and comparing them with the Sham-laser group. Materials and Methods: Twenty-six patients with intra-renal AKI (24-95 years old) at Tajrish Hospitals were evaluated for enrollment eligibility in this clinical trial study. This study was conducted at the nephrology department of Shahid Beheshti University of Medical Science, Tehran, Iran, between 2018 and 2019. Based on the treatment method, the patients' assignment to two groups (ILIB or Sham-laser) was randomly done. Demographic characteristics, need for dialysis, hemoglobin and serum biochemistry changes, serum and urine neutrophil gelatinase-associated lipocalin (NGAL) changes, laser complications, and the hospitalization period were recorded. Results: In terms of the baseline characteristics and biochemistry serum level, no differences were seen between the two groups. All post-treatment parameters, except the hemoglobin value, significantly improved in both groups. Urine NGAL and serum NGAL show declines from the baseline in both groups; however, the reduction slope of these parameters occurred faster in the laser group in a statistically significant manner. Conclusion: A decline in NGAL levels in the laser group during the treatment may suggest that the ILIB can help patients with AKI recover better., (Copyright © 2021 J Lasers Med Sci.)

Purpose: To evaluate the safety and efficacy of holmium LASER resection of the bladder tumor (HoLRBT) vs. transurethral resection of bladder tumor (TURBT) as the first treatment modality for non-muscle-invasive bladder cancer (NMIBC)., Materials and Methods: Eighty-eight patients with primary non-muscle invasive bladder cancer were allocated randomly in two groups who were treated with HoLRBT or TURBT. The intraoperative and postoperative characteristics and complications of the HoLRBT and TURBT groups were compared. The data of operation time, obturator nerve reflex rate, bladder perforation, bladder irrigation, catheterization time, hospital stay, and 1, 3, 6, 12, 18 months recurrence free survivals were considered in two groups., Results: There was not significant difference in operative duration among the two groups. Compared with the TURBT group, HoLRBT group had less intraoperative and postoperative complications, including obturator nerve reflex, transient hematuria and postoperative bladder irritation. There were no significant differences among the two groups in the transfusion rate and occurrence of urethral strictures. Patients in the HoLRBT group had less catheterization and hospitalization time in comparison to those in the TURBT group. There were no significant differences in the overall recurrence rate among the TURBT and HoLRBT groups., Conclusion: HoLRBT can be regarded as a safe and efficient method with several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in patients with non-muscle invasive bladder cancer.

Purpose: There are some previous reports on the relationship between pathological grades and HPV detection. To determine the Human Papilloma Virus(HPV)  DNA in Tumor Tissue and Urine in Different Stage of Bladder Cancer conducted this study.Materials and Methods: Polymerase chain reaction (PCR) was used to detect general HPV and HPV16 and 18 subtypes in 110 bladder tumor tissue and urine specimens of patients with TCC of bladder between January 2014 to May 2016 that underwent transurethral resection of bladder tumor. Exclusion criteria were genital wart and cases with immunosupression., Results: Mean age of 110 patients was 61.6±10 years and fourteen (12.7%) of patients were female. PCR for general HPV primer in bladder tumor tissue was positive in 3 (9.4%), 22 (38.6%) and 15 (71.4%) of Ta, T1 and T2 bladder tumors, respectively (p<0.001). PCR for HPV16 in bladder tumor tissue was positive in 2(6.3%), 10 (17.5%) and 13 (61.9%) and PCR for HPV18 in bladder tumor tissue was positive in 1 (3.1%), 14 (24.6%) and 12 (57.1%) of Ta, T1 and T2 bladder tumors, respectively (p<0.001, p<0.001). Thirty seven (33.6%) of urine specimens were positive for general HPV using PCR and HPV16 and 18 subtypes were positive in 17 (15.5%) and 14 (12.7%) of urine specimens, respectively., Conclusion: HPV infection may be associated with higher stages and grades of bladder carcinomas. Urine sampling for HPV detection is is as reliable as tumor tissue sample which could be considered for prognostic and follow up implications.

Purpose: Chronic inflammation is an important factor in the etiology of prostate cancer. Macrophage migration inhibitory factor (MIF) plays an important regulatory role in inflammatory responses. The aim of this study was to investigate the potential association between MIF-173 G/C polymorphism, and both biological behavior and incidence of prostate cancer., Materials and Methods: Analysis of polymorphic variants for MIF was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in 128 subjects with prostate cancer and 135 controls., Results: The frequency of MIF-173 *C allele was significantly (OR = 2.18, 95% CI = 1.32-3.61) higher in patients with prostate cancer (19.5%) than in healthy individuals (10%). Prostate cancer patients with Gleason scores ? 7 had higher frequency of MIF-173 *C allele than Gleason scores < 7 (86.1% vs. 27.1%, P = 0.003, OR = 3.18, 95%CI = 1.46-6.95). The frequency of MIF-173 *C allele was significantly different in patients with T1, T2 and ?T3 clinical stages of prostate cancer (15.2% vs. 42.6% and 47.8%, P = 0.003)., Conclusion: Our data suggest that MIF-173 polymorphisms may be associated with a higher incidence of prostate cancer compared to controls. We believe that MIF-173 GC+CC genotype can be used as a predictive factor for aggressive behavior of prostate cancer including pathological stage and Gleason scores as well as metastatic potential.

Purpose: To compare outcomes of retrograde intrarenal surgery (RIRS) with extracorporeal shock wave lithotripsy (SWL) for stones &le; 2 cm., Materials and Methods: Patients who were diagnosed with kidney stones of &le; 2 cm underwent RIRS or SWL in a parallel group randomized clinical trial with balanced randomization [1:1] from 2011 to 2014. The primary outcome of interest was stone free rate after a single session intervention. Patients were evaluated by ultrasonography and KUB at 1 and 3 months after the intervention for the presence of residual stone by a radiologist who was blinded to the study., Results: The stone free rate one month after a single session intervention in the RIRS group was higher than the SWL group (90% versus 75%, P = .03). The success rates after two sessions of RIRS versus SWL were 96.7% versus 88.3% respectively. (P = .08) Patients in the RIRS group had significantly lower postoperative visual analogue pain score compared to the SWL group (5.2 &plusmn; 2.8 versus 3.1 &plusmn; 2.7, P &lt; .001). Steinstrasse formation and renal hematoma were observed in 4 and one patient in the SWL group versus no patient in the RIRS group. Postoperative hospital stay was significantly shorter in the SWL group (6.7 &plusmn; 1.3 versus18.9 &plusmn; 4.3 hours, P &lt; .001)., Conclusion: The RIRS procedure is a safe treatment option for renal stones of &le;2cm with less pain and higher success rate at first session compared to SWL.&nbsp.

Introduction: To compare outcomes of retrograde intrarenal surgery (RIRS) with extracorporeal shock wave lithotripsy (ESWL) as treatment of choice., Methods: A total number of 46 patients with renal pelvic stones 10-20 mm and body mass index (BMI) >30 randomized in two groups underwent RIRS and ESWL from 2011 to 2014 and followed for 3 months., Results: The patients mean ± SD age was 36.1 ± 13.1 years in ESWL and 33.2 ± 11.4 years in RIRS groups (P = .1) with comparable BMI in both groups (36.2 vs 38.1). In ESWL and RIRS groups, the operation time was 72.2 ± 21 vs 66.5 ± 19 minutes (P = .061), respectively. Stone free rate (SFR) at 3 months was 68% in ESWL group vs 90.4% in RIRS group (P = .019). The complication rate was 20% in ESWL group vs 14.2% in RIRS group (P = .211) but all of them were minor and managed conservatively., Conclusion: According to our study, RIRS procedure in comparison with ESWL is a safe and successful option of treatment for renal pelvis stone of 10-20 mm in obese people.

Background: Vesicovaginal fistulas (VVF) are an uncommon but serious complication of gynecological surgery. The aim of this study was to report our experience with the repair of VVF using combined vaginal and extraperitoneal abdominal approaches., Materials and Methods: Between 2000 and 2012, 15 consecutive females with VVF were managed with combined vaginal and extraperitoneal abdominal procedures. After assessment by voiding cystourethrography and urethrocystoscopy, the operation was performed at the standard lithotomy position., Result: Fifteen patients were included in this study with mean age 51.8 ± 11.9 years. The mean fistula size was 2.1 ± 0.7 cm and all of them were located in supra-trigonal region except one case that fistula defect extend to the bladder trigon. Fourteen patients reported complete resolution of urinary incontinence during mean follow-up of 3.5 years. Fistula was recurred in one female 1 year after repair due to cancer recurrence and radiotherapy treatment. No intraoperative complication including massive bleeding or ureteral damage was observed., Conclusion: Our experience with combined vaginal and extraperitoneal abdominal repair of a vesicovaginal fistula shows its feasibility and safety with good results.

Purpose: To compare outcomes of diode laser vaporization of prostate with transurethral resection of the prostate (TURP) as a gold-standard treatment., Materials and Methods: A total number of 115 patients with benign prostatic hyperplasia underwent TURP and 980-nm diode vaporization of prostate in a balanced randomization (1:1) from 2010 to 2012 and were followed up for 24 months. Baseline characteristics of the patients, perioperative data, and postoperative outcomes were compared. The primary end point of the study was assessing the values of International Prostate Symptom Score (IPSS), and maximum flow rate (Qmax) to predict the functional improvement of each group. The trial is registered at http://www.irct.ir (number IRCT201202138146N3)., Result: The mean age (± standard deviation) of the patients was 68.2 ± 7.8 years in TURP and 68.5 ± 8.8 in diode groups. In TURP and diode groups, the operation time was 54.9 ± 15.3 vs 60.6 ± 22.6 minutes (P = .14), Foley catheterization time was 88.9 ± 22.5 vs 20.1 ± 4.6 hours (P = .0001) and postoperative hospital stay was 59.9 ± 14.4 vs 25.8 ± 9.2 hours (P = .0001) respectively. Outcome with regard to increase in Qmax, decrease in IPSS, and decrease in postvoid residual urine volume showed a dramatic improvement in both groups during the first 6 months. In the TURP group, the values of IPSS and Qmax were respectively lower and higher than diode patients at 12 and 24 months of follow-up., Conclusion: According to our study, diode laser vaporization (980 nm) offers a safe and feasible procedure in the management of patients with symptomatic benign prostatic hypertrophy; however, at longer follow-up the functional outcome of diode laser vaporization has been less efficient than TURP., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: Due to the negative impact of radiation on the patient and the surgical team during percutaneous nephrolithotomy (PCNL), we aimed to evaluate success rate and complications of blind access for PCNL using lumbar notch landmark and compare with conventional fluoroscopy-guided access., Materials and Methods: In a clinical trial, 100 patients who were candidate for PCNL, were randomly assigned into blind group (1) and fluoroscopy-guided group (2). In group 1 the lumbar notch was used to guide percutaneous access and in group 2 fluoroscopy performed after needle insertion, Amplatz placement and at the end of surgery. If the access failed, we would repeat puncturing up to 5 times. In group 2, access was achieved using full fluoroscopy guidance. All patients underwent postoperative assessment including kidney-ureter-bladder X-ray and ultrasonography., Results: Both mean access time and mean operation time were statically similar in group 1 and group 2 (3.3 ± 0.5 vs. 3.6 ± 0.7 min and 35.2 ± 4.6 vs. 38.9 ± 4.1 min, respectively). A successful puncture was achieved in 86% and 94% of the patients in groups 1 and 2, respectively (P = .18). Total success rate of procedure was 80% and 88% of the patients in groups 1 and 2, respectively (P = .27)., Conclusion: According to this study, it seems that blind access is a safe and effective PCNL method, and we recommend employment of this technique by skilled endourologist in urology centers especially for patient with large hydronephrotic kidney.

Purpose: To compare efficacy and safety of holmium:YAG laser and pneumatic lithotripter in the management of ureteral stones., Materials and Methods: One hundred and twelve patients with 1 to 2 cm ureteral calculi were selected for pneumatic or holmium:YAG laser transurethral ureterolithotripsy (56 patients in each group). Ultrasonography and plain abdominal x-ray were performed for all the patients before the operation. The pneumatic lithoclast was Swiss LithoClast, while in laser lithotripsy, holmium:YAG laser frequency was used, which was usually set between 5 and 10 Hz at a power of 10 to 15 Watt. Intravenous urography was performed for all the patients at 3 months to assess functional status and to delineate the ureteral anatomy., Results: The mean patients' age and stones' size were the same in both groups, and there were no statistical differences. Mean duration of lithotripsy was 13.7 ± 12.6 minutes in laser group and 7.9 ± 4.2 minutes in pneumatic lithotripsy group. Immediate stone-free rate was 100% and 82.1% in the laser and pneumatic groups, respectively (P = .001). Stone pushing back occurred only in 10 (17.9%) patients in pneumatic group. In terms of complications, such as perforation, mucosal injury, and bleeding, there were no differences between the two groups. No intravenous pyelography related complication was seen at 3-month follow-up., Conclusion: Laser lithotripsy is a superior approach for the management of upper ureteral stones of 1 to 2 cm in size due to its higher rate of stone clearance.

Purpose: The aim of study was to evaluate the clinical outcomes of PNL in comparison with laparoscopic ureterolithotomy (LUL) in proximal ureteral stones larger than 1 cm., Materials and Methods: A total of 80 patients who were candidates for treatment of large ureteral stones in our urology center were enrolled in the study between September 2004 and September 2008. By using patient randomization, they were assigned into two forty-patient groups (PNL and LUL). After evaluating the patients with laboratory tests and IVP, PNL was performed under sonography guidance in the prone position or the patients were submitted to classic laparoscopic ureterolithotomy (LUL) transperitoneally. All patients underwent postoperative assessments including KUB and ultrasonography., Results: A hundred-percent success was achieved in both groups. The mean age of the patients were 39.4 (16-63) and 35.2 (18-57) years old in PNL and LUL groups, respectively. The mean stone size in PNL group was 14.2 (10-25) mm and in LUL group was 13.5 (10-28) mm. The duration of the operations were 54.35 (50-82) minutes, and 82.15 (73-180) minutes (P < 0.0001); and the average hospital stay days were 2.6 (2-5) and 3.5 (3-8) days (p = 0.011) in groups PNL and LUL, accordingly. The mean Hb decrease in PNL group was 0.9mg/dL and in LUL group was 0.4mg/dL (p = 0.001). No statistically significant differences in terms of blood transfusion, fever, ICU admission, and prolonged urinary leakage were detected in both groups., Conclusion: According to our study, percutaneous nephrolithotomy under ultrasonography guidance is comparable with the laparoscopic ureterolithotomy for the treatment of proximal ureteral stones larger than 1 cm.

Purpose: To assess the accuracy of voided urine cytology versus urinary nuclear matrix protein 22 (NMP22) qualitative assay in the diagnosis of various grades and stages of recurrent bladder transitional cell carcinoma (TCC)., Materials and Methods: From July 2007 to February 2009, all patients with history of superficial bladder TCC were included in this multi-center study. Each patient provided three serial voided urine samples for cytologic examination and one sample for the NMP22 qualitative assay prior to urethrocystoscopy. The sensitivity and specificity of urine cytology and the NMP22 test were determined., Results: The sensitivities of the NMP22 test and cytology for detection of recurrence were 78.8% and 44.2%, respectively (P = .001), while the specificities were 69.6% and 83.7%, respectively (P = .019). The NMP22 test showed significantly higher sensitivity than cytology in detecting recurrences in low-risk and intermediate-risk groups., Conclusion: The NMP22 assay could be used for detection of superficial bladder cancer, especially in low- and intermediate-risk groups; however, the value of the test is limited by its low specificity.

Purpose: To assess the necessity of placing a ureteral stent after transperitoneal laparoscopic ureterolithotomy (TPLU)., Patients and Methods: In the period from May 2006 to November 2010, 46 patients underwent TPLU. There were 13 females and 33 males. All patients had an impacted stone larger than 1.5 cm in the upper and middle parts of the ureter. TPLU was performed as either a primary therapy or as a salvage therapy in patients in whom another treatment had failed. The exclusion criteria were pregnancy, a body mass index more than 35, and patients with abnormal results on coagulative tests. In all cases, after removing the stone, the ureter was sutured. In the first 23 patients, no ureteral catheter was placed, but in the second 23 patients, a Double J catheter was inserted through the ureter., Results: In one case, the stone was pushed back. The stone-free rate was 97.8%. There were four cases of prolonged urinary leakage after the surgery. All of them were in the group in whose members the Double J catheter had not been placed. The problem was resolved in one patient spontaneously after 4 days, but for the other three patients, a Double J catheter was placed and the leakage was stopped in 24 hours. There was no case of urinary leakage in the second group of patients with a placed Double J catheter., Conclusion: Placing a Double J catheter during surgery does not increase the time of operation and may play a role in prevention of urinary extravasation after laparoscopic ureterolithotomy.

Purpose: To compare arterial blood gas analysis of patients who underwent percutaneous nephrolithotomy (PCNL) in flank position under ultrasonography guidance with PCNL in prone and supine positions under fluoroscopic guidance., Materials and Methods: In a clinical trial, a total of 90 patients with no upper urinary tract abnormalities were candidate for the PCNL. They were assigned into three groups using pseudorandomization method (30 patients in each group). Patients in group 1 underwent ultrasonography-guided PCNL in flank position. Patients in groups 2 and 3 underwent fluoroscopic-guided PCNL in prone and supine positions, respectively. Arterial blood gas was taken just before and 20 minutes after repositioning., Results: The patients' mean age was 40.8 ± 6.9, 39.4 ± 10.6, and 37.2 ± 11.1 years in flank, prone, and supine positions, respectively (P = .69). The mean body mass index was 27.8 ± 3.4, 26.7 ± 4.7, and 28.1 ± 5.1 kg/m² in flank, prone, and supine positions, respectively (P = .21). Arterial oxygen pressure (PaO₂) increased significantly in flank (111.7 ± 43.8 to 132.8 ± 58.1 mmHg; P = .01) and prone (118.6 ± 50.2 to 134.6 ± 58.5 mmHg; P < .001) positions and decreased nonsignificantly in supine group (121.7 ± 64.5 to 119.7 ± 60.9 mmHg; P = .23). With surgical positioning, there were no significant changes demonstrated in PaCO₂ and serum concentration of HCO₃ in the flank, prone, and supine groups., Conclusion: We could suggest that flank and prone positions could improve patients' oxygenation during PCNL procedure.

Purpose: To evaluate success rate of dorsal versus ventral oral mucosal graft for anterior urethroplasty., Materials and Methods: In a retrospective study, the results of the ventral and dorsal oral mucosal graft (OMG) anterior urethroplasty were assessed in 24 and 29 patients, respectively. Demographic and clinical characteristics of subjects were gathered from the medical records., Results: Patients were followed up for a mean duration of 32 months (range, 25 to 51 months). The success rates of dorsal and ventral anterior OMG urethroplasty were 83.3% and 75.8%, respectively (P = .5). At penile site, dorsal and ventral OMG were done for 9 and 10 patients with stricture lengths of 3.7 ± 1.1 cm and 3.9 ± 1.2 cm, respectively (P = .7). Success rates of dorsal and ventral penile OMG were 88.9% and 70%, respectively (P = .3). At the bulbar site, dorsal and ventral OMG were performed on 15 and 19 patients with stricture lengths of 4.1 ± 1.1cm and 4.2 ± 1.5 cm, respectively (P = .7). The success rates of dorsal and ventral bulbar OMG were 80% and 79%, respectively (P = .94)., Conclusion: Oral mucosal graft is a versatile and an effective procedure for management of strictures throughout the anterior urethra, and in experienced hands, the outcomes are similarly favorable whether a dorsal or ventral approach is taken.

Purpose: To compare dorsal versus ventral anterior urethral spatulation in posterior urethroplasty., Materials and Methods: In a retrospective study, we evaluated the records of 320 posterior urethroplasties which have been done in our center over a 7-year period from January 2000 to December 2006. The results of dorsal and ventral anterior urethral spatulations were compared., Results: The studied subjects consisted of 264 men and 54 prepubescent boys (≤ 15 years) with the mean age of 23 years (range, 5 to 84 years). The mean follow-up was 52 months (range, 27 to 107 months). Six o'clock (group A) and 12 o'clock (group B) anterior urethral spatulations were performed in 101 (32%) and 219 (68%) of the patients, respectively. The success rates were 96% and 87.6% in groups A and B, respectively (P = .025). There were no urethro-rectal fistula and perineal wound infection during the follow-up period., Conclusion: Our data suggest that the dorsal anterior urethral spatulation in urethroplasty is more efficient than ventral anterior urethral spatulation in terms of treatment success outcome.

Purpose: Pelvic fracture urethral distraction defect is usually managed by the end to end anastomotic urethroplasty. Surgical repair of those patients with post-traumatic complex posterior urethral defects, who have undergone failed previous surgical treatments, remains one of the most challenging problems in urology. Appendix urinary diversion could be used in such cases. However, the appendix tissue is not always usable. We report our experience on management of patients with long urethral defect with history of one or more failed urethroplasties by Monti channel urinary diversion., Materials and Methods: From 2001 to 2007, we evaluated data from 8 male patients aged 28 to 76 years (mean age 42.5) in whom the Monti technique was performed. All cases had history of posterior urethral defect with one or more failed procedures for urethral reconstruction including urethroplasty. A 2 to 2.5 cm segment of ileum, which had a suitable blood supply, was cut. After the re-anastomosis of the ileum, we closed the opened ileum transversely surrounding a 14-16 Fr urethral catheter using running Vicryl sutures. The newly built tube was used as an appendix during diversion., Results: All patients performed catheterization through the conduit without difficulty and stomal stenosis. Mild stomal incontinence occurred in one patient in the supine position who became continent after adjustment of the catheterization intervals. There was no dehiscence, necrosis or perforation of the tube., Conclusion: Based on our data, Monti's procedure seems to be a valuable technique in patients with very long complicated urethral defect who cannot be managed with routine urethroplastic techniques.