Simplified technique to create a concealed catheterizable stoma: the VR flap

Area of Science:

• Urology
• Pediatric Surgery
• Reconstructive Surgery

Background:

• Continent catheterizable channels are crucial for managing bladder and bowel dysfunction.
• Existing techniques for creating these channels can be complex and prone to complications like stenosis and mucosal prolapse.

Purpose of the Study:

• To describe a novel surgical modification of VQZ plasty, termed the VR flap, for creating continent catheterizable channels.
• To evaluate the safety, efficacy, and cosmetic outcomes of the VR flap technique.

Main Methods:

• The VR flap modification involved using a quadrilateral flap positioned at a 90-degree angle to the V flap.
• This technique was applied in 12 pediatric patients undergoing simultaneous creation of Mitrofanoff and MACE procedures.
• The quadrilateral flap creates a skin channel, allowing for a shorter conduit and preventing exposed mucosa.

Main Results:

• A total of 24 continent catheterizable channels (CCCs) were created in 12 patients.
• Channels were implanted in the umbilicus or a stoma created by the VR flap, with no significant complications reported.
• All patients achieved continence through their channels, with a mean follow-up of 18 months.

Conclusions:

• The VR flap modification provides excellent cosmetic and functional results for continent catheterizable channels.
• The procedure is straightforward to perform and understand, with favorable outcomes compared to other series.
• This technique is versatile, not limited by abdominal wall thickness, and simplifies the closure process.