How to avoid a Monti.

This communication highlights the approaches for antegrade continence enema (ACE) creation that preserve the appendix for the Mitrofanoff, streamline combined reconstructions, and reduce operative complexity and complications associated with Monti techniques. These include a split appendix technique, extension of the appendiceal base, a neo-Malone appendicostomy and use of a non-plicated appendicocecostomy for patients in need of an ACE but who are not yet ready for their definitive urologic reconstruction. These techniques give preference for use of the appendix for the Mitrofanoff and provide options for an ACE channel either simultaneous or asynchronous with other procedures.