In this video we define and present surgical technique of extended spiral monti (ONEM) as a new continent cutaneous diversion in seventeen years old male patients with spinal dysraphism.

Lower abdominal midline incision was made and abdomen was opened. In order to put the autologous rectus fascial sling placement dissection was carried out to underneath urethra through between posterior bladder wall and rectum. Endopelvic fascia was opened bilaterally in order to visualization of bladder neck and urethra. 8,5 cm and 30 cm ileum was isolated for ONEM conduit and augmentation cystoplasty. Both distal and proximal tip of 8cm ileal segment was cut into spiral shape and created 1.7 cm width, 6 cm length flap. Than 5 cm middle segment was excise antimesenteric part of ileum over 16 Fr foley catheter with stapler. Spiral flaps were tubularized over 16 fr catheter and closed as a continuation of middle part. 17 cm conduit was created (Figure-1). Fixation sutures was placed on anterior bladder wall and bladder was opened in sagittal axis direction. Urethral foley catheter and cystostomy were placed. Autologous fascial sling was placed underneath bladder neck. ONEM conduit was anastomosed on right bladder dome with submucosal tunnel creation. 30cm ileum was detubularized and hemispheric shaped was created. Watertight anastomosed were done between bladder and hemispheric ileal segment with bladder with 3-0 polyglactin suture. ONEM conduit were anastomosed right side of umbilicus. Drain was placed and abdominal incision was closed.

Modified extended spiral monti (ONEM) is effective and safe method.

Modified extended spiral monti (ONEM) can be used for patients with NLUTD when need upper level placement of conduit for catheterizable continent cutaneous diversion. This conduit also suitable for obese neurogenic patients due to 4,5-5 cm pedicle free channel on both tip of conduit.