Long-term outcomes of catheterizable continent urinary channels: What do you use, where you put it, and does it matter?

Szymański, Konrad M.; Whittam, Benjamin; Misseri, Rosalia; Flack, Chandra K.; Hubert, Katherine C.; Kaefer, Martin; Rink, Richard C.; Cain, Mark P.

doi:10.1016/j.jpurol.2015.05.002

Cited by 52 publications

(44 citation statements)

References 28 publications

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“…Specifically, we found the problems related to obesity to be significantly more common in patients managed with a Monti–Yang tube (87%; 13/15) or APV (55%; 18/33) compared with patients with a tapered ileum and reinforced ileal–cecal valve (27%; 8/30), P < 0.00015 and P < 0.025, respectively (Table ). We hypothesize that improved blood flow of the tapered ileum might prevent ischemic stricture formation, and that the straight channel of the tapered ileum does not result in the angulation and saculation defects that can arise with weight gain found in patients with an APV or Monti–Yang tube . Our findings regarding significantly more complications found with Monti–Yang tubes compared with an APV are consistent with previously published data .…”

Section: Non‐lethal Complications After Bladder Augmentationsupporting

confidence: 91%

“…Similarly, the development of obesity in our patient population is associated with a high incidence of subfascial stricture formation with or without the parallel development of a false passage. We hypothesize that the association of these complications in relationship to obesity is due to vascular compromise of the catheterizable limb that might occur with elongation and angulation of the catheterizable limb that occurs with weight gain . Specifically, we found the problems related to obesity to be significantly more common in patients managed with a Monti–Yang tube (87%; 13/15) or APV (55%; 18/33) compared with patients with a tapered ileum and reinforced ileal–cecal valve (27%; 8/30), P < 0.00015 and P < 0.025, respectively (Table ).…”

Section: Non‐lethal Complications After Bladder Augmentationmentioning

confidence: 82%

“…In this study, 66 patients with an APV, 63 patients with a cecal bladder augmentation with a reinforced ileal–cecal valve and 30 patients with a Monti–Yang tube were reviewed. Please note all spiral Monti and double Monti tubes were excluded from this analysis because of their known 2–4‐fold increased risk of stomal complications over APV . Table shows our success regarding long‐term urinary continence and the incidence of stomal complications.…”

Section: Non‐lethal Complications After Bladder Augmentationmentioning

confidence: 99%

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Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: Incidence and management of the non‐lethal complications of bladder augmentation

Husmann

2017

Int J of Urology

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The present review provides clinical insights and makes recommendations regarding patient management garnered by the long-term follow up of patients undergoing enteric bladder augmentation for the management of congenital anomalies. A prospectively maintained database on 385 patients that have experienced an enteric bladder augmentation, using either the ileum or colon, was reviewed. Evaluations included methods used to prevent bladder calculi formation and recurrence, the incidence and etiology of renal calculi development, the incidence and treatment of vitamin B 12 deficiency, and the complications and need for surgical revisions for continent catheterizable stomas. A significantly increased risk for continent catheterizable stomal complications occurred after Monti-Yang tube formation, 70% (21/ 30 patients), compared with appendicovesicostomy, 41% (27/66 patients), P = 0.008. Both procedures had significantly more complications than continent catheterizable stomas using tapered ileum with a reinforced ileal-cecal valve, 21% (13/63 patients), P < 0.0001 and P < 0.013, respectively. Approximately 50% of the patient population developed a body mass index ≥30 during adulthood. The onset of obesity resulted in significantly more complications developing in patients with a Monti-Yang tube (87%; 13/ 15 patients) or appendicovesicostomy (55%; 18/33 patients) compared with a tapered ileum with a reinforced ileal-cecal valve (27%, 8/30 patients), P < 0.00015 and P < 0.025, respectively, with a median follow-up interval of 16 years, range 10-25 years. Long-term follow-up evaluations on patients undergoing an enteric bladder augmentation are necessary to prevent the long-term sequela of this procedure. The key to improving patient prognosis is the nutritional management of the patient as they mature, especially if a continent abdominal stoma is going to be carried out.

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Section: Non‐lethal Complications After Bladder Augmentationsupporting

confidence: 91%

Section: Non‐lethal Complications After Bladder Augmentationmentioning

confidence: 82%

Section: Non‐lethal Complications After Bladder Augmentationmentioning

confidence: 99%

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Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: Incidence and management of the non‐lethal complications of bladder augmentation

Husmann

2017

Int J of Urology

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“…Two of the largest pediatric series note revision rates of 11.7% and 24%. 5,14 Among 144 adults, Wiesner et al reported 17% revision rate for stomal stenosis; the mean time to stenosis was 43.8 months. 6 Redshaw et al in a study of 61 adult patients with cutaneous catheterizable ileal cecocystoplasty found only 3-13% stenosis rate with a relatively short follow-Surgical revision of catheterizable channel obstruction up of 16 months.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of revision surgery for difficult to catheterize continent channels in a multi-institutional cohort of adults

Pagliara¹,

Gor

Liberman³

et al. 2017

CUAJ

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Introduction: We aimed to describe the strategies of surgical revision for catheterizable channel obstruction and their outcomes, including restenosis and new channel incontinence. Methods: We retrospectively queried the charts of adults who underwent catheterizable channel revision or replacement from 2000-2014 for stomal stenosis, channel obstruction, or difficulty with catheterization at the Universities of Minnesota, Michigan, and Utah. The primary endpoint was channel patency as measured by freedom from repeat surgical intervention. Secondary endpoints included post-revision incontinence and complication rates. Revision surgeries were classified by strategy into "above fascia," "below fascia," and "channel replacement" groupings. Results: A total of 51 patients who underwent 68 repairs (age 18-82 years old; mean 45) were identified who met our inclusion criteria. Channel patency was achieved in 66% at a median 19 months post-revision for all repair types. There was no difference in patency by the type of channel being revised, but there was based on revision technique, with channel replacement and above the fascia repairs being more successful (p=0.046). Channel incontinence occurred in 40% and was moderate to severe in 12%. The type of channel being revised was strongly associated (p=0.003) with any postoperative channel incontinence. Surgical complications occurred in 29% of all revision procedures, although most were low-grade. Conclusions: Surgical revision of continent catheterizable channels for channel obstruction can be performed with acceptable rates of durable patency and incontinence; however, the surgeon needs to have experience in complex urinary diversion and familiarity with a variety of surgical revision strategies.

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“…While stomal stenosis, stomal revision procedures and channel continence were similar between APV and Monti channels, patients who underwent Monti catheterizable channels were twice as likely to require subfascial revision at 10 years follow-up. The longer spiral Mmonti channels to the umbilicus carried the greatest requirement for subfascial revision (82,83). Complications continued to arise over the lifetime of the channel.…”

Section: Catheterizable Channelsmentioning

confidence: 99%

Long-Term Sequela of Pediatric Bladder Reconstruction

Roth

Keenan

Cain

et al. 2015

Curr Bladder Dysfunct Rep

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Children with refractory neurogenic bladder (NGB) who have failed maximal medical management are presented with options for bladder reconstruction. It is critical to understand the long-term sequela of bladder augmentation and bladder neck reconstruction to properly counsel families regarding these procedures. Benefits may include preservation of renal function, continence, reduced risk of renal-related mortality and potential improvements in quality of life (QOL). However, these advantages must be balanced with the risks of bladder calculi, perforation, need for additional surgery, acid/base disturbances, vitamin B12 deficiency and malignancy. Therefore, careful patient selection and preoperative counseling are paramount for those undergoing bladder reconstruction which includes intestinal bladder augmentation, as these patients require lifelong vigilant follow-up. IntroductionChildren with neurogenic bladders (NGB) are initially managed with clean intermittent catheterization (CIC) and anticholinergic medications in order to maintain a sizable, continent, and compliant urinary reservoir. Despite early and aggressive intervention, some patients undergo lower urinary tract reconstruction (bladder augmentation, catheterizable channel and/or bladder neck reconstruction) to protect their upper tracts and achieve continence. In a few select patients with favorable urodynamics (UDS) and low outlet resistance, a bladder neck procedure (BNP) can be performed without bladder augmentation to achieve continence. Myelodysplasia, specifically spina bifida (SB), remains the most common etiology of NGB in the pediatric population. Due to medical advances, particularly in the realm of Urology, more SB patients with bladder reconstruction are surviving into adulthood. We review current literature regarding long-term sequela of bladder reconstruction in pediatric patients with neurogenic bladder, with a primary focus on bladder augmentations for refractory NGB secondary to SB.

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Long-term outcomes of catheterizable continent urinary channels: What do you use, where you put it, and does it matter?

Abstract: Runninghead: Long-term outcomes of catheterizable urinary channels

Cited by 52 publications

References 28 publications

Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: Incidence and management of the non‐lethal complications of bladder augmentation

Lessons learned from the management of adults who have undergone augmentation for spina bifida and bladder exstrophy: Incidence and management of the non‐lethal complications of bladder augmentation

Outcomes of revision surgery for difficult to catheterize continent channels in a multi-institutional cohort of adults

Long-Term Sequela of Pediatric Bladder Reconstruction

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