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Lessons learned from stomal complications in children with cutaneous catheterizable continent stomas
Albaha Barqawi1, Miguel de Valdenebro, Peter D Furness
1Department of Surgery, Division of Urology, University of Colorado School of Medicine, Denver, Colorado, USA. Al.Barqawi@uchsc.edu
Insights
Stomal complications are common in children undergoing continent catheterizable urinary (CCU) and Malone antegrade colonic enema (MACE) stoma creation. However, high continence rates justify the procedures, with older age and neurogenic bladder increasing complication risks.
Area of Science:
- Pediatric Surgery
- Urology
- Gastroenterology
Background:
- Continent catheterizable urinary (CCU) and Malone antegrade colonic enema (MACE) stomas are surgical reconstructions for urinary and fecal continence in children.
- Stoma-related complications can impact patient outcomes and require further interventions.
Purpose of the Study:
- To identify factors influencing stoma complication rates in pediatric CCU and MACE stoma construction.
- To evaluate the overall success and complication profile of these procedures.
Main Methods:
- Retrospective review of 109 pediatric patients with 151 CCU and/or MACE stomas constructed between 1992 and 2003.
- Analysis of diagnoses, stoma type, site, conduit material, patient demographics, and concomitant surgeries for complication correlation.
Main Results:
- High success rates for stomal continence (97% CCU, 99% MACE).
- Common complications included stenosis (27), leakage (8), and false passage (4).
- Older age at surgery and neurogenic bladder diagnosis were independent risk factors for increased stoma complications and revisions.
Conclusions:
- Despite frequent complications necessitating revision, CCU and MACE stomas offer high continence rates, supporting their continued use in pediatric patients.
- Age and neurogenic bladder are significant predictors of stoma-related complications, guiding surgical decision-making and patient counseling.
Objective:
To evaluate the impact of various factors that might ultimately influence the stoma complication rate associated with the construction of a continent catheterizable urinary (CCU) and Malone antegrade colonic enema (MACE) stoma in children.
Patients And Methods:
Retrospectively, we reviewed our experience in patients who had a CCU and/or MACE stoma reconstructed at our institution from 1992 to 2003. Diagnosis, type of stoma constructed (CCU vs MACE), single vs dual stomas, stomal site, conduit material (appendix, split appendix, Monti-Yang or ureter), sex, age, patient mobility and body mass index, race and concomitant surgery (e.g. bladder augmentation with or without bladder neck reconstruction) were evaluated for stoma-related complications. In all, 109 patients (64 males and 45 female), with a mean (sd, range) age of 8.6 (5.7, 2-37) years, had 151 stomas constructed during the period of analysis, comprising 56 CCU only, 11 MACE only and 42 (84 stomas) both simultaneously.
Results:
The mean (range) follow-up was 48 (6-144) months. The primary diagnoses were neurogenic bladder in 60 (55%), bladder exstrophy/epispadias in 17 (16%) and posterior urethral valves in 11 (9%) patients. The umbilicus was the primary site for the CCU stoma in 88 of 98 (90%) cases, while the right lower quadrant was the primary site for MACE in 46 of 53 (87%). After surgery complete stomal continence was provided in 95 of 98 (97%) CCU stoma, whereas the MACE was successful in 52 of 53 (99%). The stoma-related complications included stenosis in 27, leakage in eight, false passage in four, atrophy in two, keloid in one, and breakdown of the stoma in two. Individually, only greater age and a primary diagnosis of neurogenic bladder were independent risk factors associated with an increased rate of stomal complications and higher incidence of revision (P < 0.05).
Conclusion:
Stomal complications are extremely common whether CCU or MACE stomas are constructed individually or together. Nevertheless, despite the need for revision, the high stoma continence rate supports their use. Greater age at surgery and a primary diagnosis of neurogenic bladder were associated with a significant increase in the stoma-related complications and the need for revision.
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