Reoperation for Channel Complications in Children With Continent Cutaneous Catheterizable Channels: The Test of Time

• Published in: Urology (Ridgewood, N.J.) Vol. 159; pp. 196 - 202
• Main Authors: Abdelhalim, Ahmed, Omar, Helmy, Edwan, Mohamed, Helmy, Tamer E., El-Hefnawy, Ahmed S., Hafez, Ashraf T., Dawaba, Mohamed E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2022
• Subjects: Appendix - surgery; Child; Cystostomy - methods; Female; Follow-Up Studies; Humans; Male; Outcome and Process Assessment, Health Care; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - surgery; Reconstructive Surgical Procedures - methods; Reoperation - methods; Reoperation - statistics & numerical data; Urinary Catheterization - adverse effects; Urinary Catheterization - methods; Urinary Catheterization - statistics & numerical data; Urinary Incontinence - diagnosis; Urinary Incontinence - etiology; Urinary Incontinence - prevention & control; Urinary Reservoirs, Continent - adverse effects; Urinary Reservoirs, Continent - statistics & numerical data; Urologic Surgical Procedures - adverse effects; Urologic Surgical Procedures - instrumentation; Urologic Surgical Procedures - methods; CIC; APV; CCCC
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2021.08.015

To examine the durability of continent cutaneous catheterizable urinary channels (CCCC) in children and assess whether channel complications continue to arise with extended follow-up. Previous studies demonstrated that complications of CCCC cluster in the early years following surgery. The database of a tertiary center was queried for patients≤21 years who underwent CCCC. Patients with <6 years of follow-up were excluded. Patients were invited for follow-up to assess continence. Clinic visits and hospital admissions were reviewed for channel complications requiring reoperation. Complications were analyzed against patient and channel characteristics and time since initial surgery. Between 1993 and 2012, a total of 120 patients underwent CCCC at a median age of 6.8(0.4-21) years and a median follow-up of 11.4(6.6-27) years. CCCC were created using the appendix, Monti channels and tapered ileal segments in 74(61.7%), 33(27.5%) and 13(10.8%), respectively. Continence relied on the extra-mural serous lined principle in 85.8% and the stoma was anastomosed to the umbilicus in 90%. Dryness with catheterization intervals of 3 hours or longer was eventually achieved in 90.8% with similar rates among different channel types (P=.149). 26(21.7%) required 42 interventions to treat channel complications with 32.5% occurring >5 years following initial surgery irrespective of the channel type (P=.978). On multivariate analysis, ileal channels had 3.372 higher odds of needing reoperation compared to appendicovesicostomy (95%CI=1.240-9.166; P = .037). A high reoperation rate is anticipated throughout the lifetime of CCCC. Appendicovesicostomy has a low complication risk relative to ileal channels.