Use and disuse of catheterizable channels as the primary method of emptying the neuropathic bladder: a single institutional cohort study

• Published in: The Journal of urology p. 101097JU0000000000004313
• Main Authors: Griffin, Yifan Meng, Misseri, Rosalia, Roth, Joshua D., Whittam, Benjamin M., Dangle, Pankaj, King, Shelly, Meldrum, Kirstan K., Kaefer, Martin, Cain, Mark P., Rink, Richard C., Szymanski, Konrad M.
• Format: Journal Article
• Language: English
• Published: 04.11.2024
• ISSN: 0022-5347; 1527-3792; 1527-3792
• DOI: 10.1097/JU.0000000000004313

We aimed to assess long-term use of continent catheterizable urinary channels (CCCs) and explore potential risk factors for disuse.PURPOSEWe aimed to assess long-term use of continent catheterizable urinary channels (CCCs) and explore potential risk factors for disuse.People undergoing appendicovesicostomy and Monti procedures at our institution were retrospectively reviewed (1991-2023). The main outcome was CCC disuse (not intermittently catheterizing channels as the primary method of bladder emptying). Cox regression was used.MATERIALS AND METHODSPeople undergoing appendicovesicostomy and Monti procedures at our institution were retrospectively reviewed (1991-2023). The main outcome was CCC disuse (not intermittently catheterizing channels as the primary method of bladder emptying). Cox regression was used.561 people (46% male, 57% shunted, 72% spina bifida) met inclusion criteria (244 appendicovesicostomy, 317 Monti; 69% right lower quadrant [RLQ]). Channels were created at a median age of 8 years (median follow up: 11 years, 78% self-catheterized). Overall, 76 people disused their channels. Most common reasons for disuse were non-mechanical (64%). After disuse, 46% underwent incontinent diversion.After correcting for differential follow-up, 89% of people still used their channels at 10 and 81% at 20 years, respectively. When analyzing all disused channels in patients reaching adulthood on multivariable analysis, channels catheterized by others had 3.78 times the risk for disuse compared to self-catheterized channels (p<0.001); RLQ channels were 1.06 times more likely to be disused than umbilical channels (p=0.02).For channels disused for non-mechanical reasons, catheterization by others, not attending transition clinic, and RLQ stoma were independently associated with disuse (p≤0.04). No variables were associated with disuse for mechanical reasons (p≥0.22).RESULTS561 people (46% male, 57% shunted, 72% spina bifida) met inclusion criteria (244 appendicovesicostomy, 317 Monti; 69% right lower quadrant [RLQ]). Channels were created at a median age of 8 years (median follow up: 11 years, 78% self-catheterized). Overall, 76 people disused their channels. Most common reasons for disuse were non-mechanical (64%). After disuse, 46% underwent incontinent diversion.After correcting for differential follow-up, 89% of people still used their channels at 10 and 81% at 20 years, respectively. When analyzing all disused channels in patients reaching adulthood on multivariable analysis, channels catheterized by others had 3.78 times the risk for disuse compared to self-catheterized channels (p<0.001); RLQ channels were 1.06 times more likely to be disused than umbilical channels (p=0.02).For channels disused for non-mechanical reasons, catheterization by others, not attending transition clinic, and RLQ stoma were independently associated with disuse (p≤0.04). No variables were associated with disuse for mechanical reasons (p≥0.22).Most people with CCCs use them on long-term follow-up. 1% stopped using them annually. People who never self-catheterized, never attended transition clinic or had RLQ stomas were at higher risk of channel disuse, particularly due to non-mechanical reasons.CONCLUSIONSMost people with CCCs use them on long-term follow-up. 1% stopped using them annually. People who never self-catheterized, never attended transition clinic or had RLQ stomas were at higher risk of channel disuse, particularly due to non-mechanical reasons.