Long-term complications of continent catheterizable channels: a problem for transitional urologists

Abstract

A majority of the transitional urology patient population have neurogenic bladder and many of these patients have undergone creation of continent catheterizable channels (CCCs) to facilitate bladder emptying. Transitional urologists will be faced with revision of these channels due to a variety of possible complications. We performed a comprehensive literature review to the data regarding the incidence, timing, and predisposing factors that lead to complications of CCCs as well as surgical revision techniques and their outcomes. Long-term channel complications and related revisions are common (25–30%) and likely underestimated. While many predictors for revision have been posited, the only predictor that has been significant in robust multivariable analysis is channel type, with appendicovesicostomies having a lower chance of requiring revision compared to Monti channels. Channels created in adults have high likelihood of requiring revision, even within a relatively short follow-up period. We review techniques for management of channel complications and their outcomes. As patients with congenital urologic conditions requiring CCCs are gaining longer lifespans, transitional urologists will be faced with revision and/or replacement of these channels. While some of these patients may require supravesical diversion in the future, data show that revision is feasible with good outcomes. Longer-term follow-up data is needed to understand the life-span and best practices of new CCCs created among the transitional population.

Managing intractable incontinence from a Yang-Monti channel in a case of enterocystoplasty with bladder neck closure – Challenges and a modified surgical technique

“…The common complications of the Mitrofanoff principle are stomal stenosis (2%–10%), channel incontinence (2%–40%), stomal prolapse (2%–5%), false passage formation, and channel kink (5%–32%). [ 2 3 ] Incontinence is often related to changes in the volume–pressure dynamics of the reservoir. Re-evaluating the urodynamic parameters of the reservoir should be the initial step.…”

“…Endoscopic bulking agent injection for management of channel incontinence has been reported with varying degrees of short-term success from 12.5% to 79%. [ 3 4 ]…”

Complications of Continent Cutaneous Catheterizable Channel in Adult

“…A total of 107 patients underwent continent catheterizable channel formation via Mitrofanoff principle were enrolled. The sample size was calculated - ----------------------------------------------------------------------------------------Received on 11-12-2021 Accepted on 27-06-2022 by using WHO calculator using frequency of stenosis (11.2%) 8 , margin of error (d=6%, confidence level (C.I=95%). Informed written consent was obtained from each participant.…”

“…The Mitrofanoff technique has showed reoperation rate of 8% for bleeding, anastomotic leak, conduit disintegration, intestinal obstruction, with the most prevalent long-term consequence being stomal stenosis, which causes difficult conduit catheterization. 7 Documented complications associated with the continent cutaneous channel in studies are stenosis (11.2%) 8 , postoperative incontinence (44.8%) 5 and surgical site infections (22.2%) 9 . Bladder augmentation is a simple idea for patients with overactive, small-capacity, and/or low compliance bladder and a normal upper urinary tract, as well as in situations with coupled sphincteric incompetence with supplementary sphincteric function support (e.g., a fascial sling surgery) 10 .…”

Medical Management of Neurogenic Bladder for Children and Adults: A Review

“…Interestingly, patients older than 21 when their channel is surgically created have higher revision rates, ranging between 31% to 54%. 48…”