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Techniques used to create continent catheterizable channels: A comparison of long-term results in children

Urology Sep 02, 2017

Polm PD, et al. – In this study, long–term results of three different techniques applied to create continent catheterizable channels (CCCs) in children in a single institution were compared. 52% require surgical revision, while catheterizable channel is an effective solution for children who cannot perform urethral catheterization. Since no differences were observed in outcome between appendicovesicostomy (APV), tubularized bladder flap (TBF) and Monti, they reveal that a TBF CCC is a good alternative for the APV. Whether the appendix is not available and bladder volume is sufficient, a TBF channel is preferred to a Monti channel.

Methods
  • Researchers retrospectively collected data from 112 children who had a CCC [appendicovesicostomy (APV), tubularized bladder flap (TBF) or Monti] created between December 1995 and December 2013.
  • Revision-free survival was considered as a primary endpoint, while channel stenosis, incontinence, and false channel requiring revision were considered as secondary endpoints.
  • They examined time-to-event survival applying a Kaplan-Meier survival curve.

Results
  • They distinguished a sum of 117 CCCs with median follow-up of 85 months.
  • They demonstrated that surgical revision was required in 52%, with no significant difference between the different techniques.
  • As per the data, major revision was required in 27% of the cases and significantly more often in Monti channels.
  • In 7%, complete revision was required.
  • In 33%, stenosis requiring revision was seen.
  • Furthermore, a false channel was formed in 9% of the cases.
  • They found incontinence with a low leak point pressure in 12%.
  • Remarkably, a time-to-event analysis with a Kaplan-Meier curve displayed no significant differences between the three techniques.
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