Contemporary multicenter outcomes of continent cutaneous ileocecocystoplasty in the adult population over a 10‐year period: A Neurogenic Bladder Research Group study

Abstract

Aims Evidence is sparse on the long‐term outcomes of continent cutaneous ileocecocystoplasty (CCIC). We hypothesized that obesity, laparoscopic/robotic approach, and concomitant surgeries would affect morbidity after CCIC and aimed to evaluate the outcomes of CCIC in adults in a multicenter contemporary study. Methods We retrospectively reviewed the charts of adult patients from sites in the Neurogenic Bladder Research Group undergoing CCIC (2007‐2017) who had at least 6 months of follow‐up. We evaluated patient demographics, surgical details, 90‐day complications, and follow‐up surgeries. the Mann‐Whitney U test was used to compare continuous variables and χ² and Fisher's Exact tests were used to compare categorical variables. Results We included 114 patients with a median age of 41 years. The median postoperative length of stay was 8 days. At 3 months postoperatively, major complications occurred in 18 (15.8%), and 24 patients (21.1%) were readmitted. During a median follow‐up of 40 months, 48 patients (42.1%) underwent 80 additional related surgeries. Twenty‐three patients (20.2%) underwent at least one channel revision, most often due to obstruction (15, 13.2%) or incontinence (4, 3.5%). Of the channel revisions, 10 (8.8%) were major and 14 (12.3%) were minor. Eleven patients (9.6%) abandoned the catheterizable channel during the follow‐up period. Obesity and laparoscopic/robotic surgical approach did not affect outcomes, though concomitant surgery was associated with a higher rate of follow‐up surgeries. Conclusions In this contemporary multicenter series evaluating CCIC, we found that the short‐term major complication rate was low, but many patients require follow‐up surgeries, mostly related to the catheterizable channel.

The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-up

“…(Conditional Recommendation; Evidence Level: Grade C) Continent catheterizable channels (CCC) may be offered to NLUTD patients who are able to perform self-catheterization but have a devastated urethra that cannot be catheterized (eg, urethral stricture, perineal pressure ulcer eroding into the urethra) or require BNC closure (ie, complete loss of the urethra due to a chronic indwelling urethral catheter). 36,37 An additional indication would be patients with normal hand dexterity and urethral function who prefer a CCC due to ease of catheterization. Preoperative counseling is required before any CCC surgery to advise the patient on potential complications, expectations, and outcomes.…”

Hemi-Kock Continent Stoma With Augmentation Cystoplasty: Modifications and Outcomes

“…The continent ileocecal augmentation cystoplasty is another effective alternative. 5 It involves exclusion of the ileocecal valve and terminal ileum from the gastrointestinal tract; this has resulted in an increased incidence of diarrhea. 22,23 The hemi-Kock system preserves the terminal ileum and ileocecal valve and has not been reported to change bowel function.…”

“…Revision rates are similar to those reported for ACs and CCCs in general. 5,19,24,27 Faure 28 reported at least one surgical revision in 61% of 54 patients with Mitrofanoff CCC, mainly constructed from appendix. The mean number of revisions was 2.2 § 0.05 and 82% were managed by endoscopic or suprafascial procedures.…”

“…In a series of 114 patients with ileocecocystoplasty CCC, 46 patients required 80 additional related surgeries at 3.3 years follow-up. 5 TwentyÀthree patients (20.2%) underwent at least one channel revision, for obstruction, 15 leakage, 4 or other reason. 4 Ten patients underwent deep revision or replacement, 9 had superficial revisions, and 3 had either bulking agent injection or superficial revision.…”

“…As an alternative to CIC the continent catheterizable channel (CCC) can be created simultaneously at the time of AC to permit bladder emptying without the need for an external appliance or indwelling catheter. [3][4][5] This is useful in patients with functional or anatomical limitations preventing urethral CIC 6 including wheelchair-dependence, neurologic conditions with reduced upper extremity dexterity, and patients with devastated urethras following surgery, trauma, or radiation.…”