Abstract General Information

Title

Long-Term Complications of Continent Catheterizable Channels

Introduction and objective

To evaluate the long-term complications of urinary and fecal continent catheterizable channels.

Method

Retrospective records review of 66 patients operated from 1999 to 2014.

Results

In 66 patients, 74 continent catheterizable channels were created: 49 urinary- and 25 fecal stomas. The mean age at operation was 9 years and the mean follow up period was 13 years. As initial pathology, 24 patients had bladder or cloacal exstrophy, 24 neurogenic bladder and bowel dysfunction, 14 anorectal malformations, 2 congenital megacolon and 2 patients had posterior urethral valves. Both the appendix and a transverse tubularized intestinal segment were used. Eight patients received both stomas.
The channels were implanted into the native bladder in 34 patients, in the intestinal segment of an augmented bladder in 14 patients and in a bladder replacement in 1 patient (Mainz-Pouch I). 42 stomas were diverted in the right lower quadrant of the abdomen, 29 in the umbilicus and 3 in the left lower quadrant.
Of the 74 stomata, 60 (81%) are functional. They are continent and easy to catheterize. In 4 patients the results are acceptable with minor problems. There were ten reoperations (13.5% of stomas, 15% of patients). Reasons for reoperations were difficult catheterization in 4, incontinence in 3 and mucosal prolapse in 3 patients. Of the 10 reoperations, 9 involved the urinary stomas and 1 a fecal stoma. Urinary incontinence was attributed to the shortening of the intravesical tunnel. No significant difference in results were observed among the different techniques used. Cutaneous anastomosis without skin flaps had to be revised because of prolapse in 3 patients and two of three incontinent channels had been constructed with tubularized ileum.

Conclusion

Catheterizable channels accomplish fecal and urinary continence in most patients with an acceptable complications rate in long term follow-up.