Effectiveness of implanting catheterizable channels into intestinal segments

To assess the effectiveness of implanting continent catheterizable channels (CCCs) into bowel segments used for bladder augmentation or substitution.

The records of patients operated on between 2000 and 2003 were reviewed. CCCs were created using the appendix or a transverse tubularized bowel, and were implanted either in the intestinal segment of an augmentation or into an intestinal continent reservoir. Implantation into the intestinal segment was preferred over the native bladder, when it allowed the stoma to be placed at the umbilicus, creating the shortest possible channel. Ease of catheterization and continence through the stoma were evaluated by clinic interviews or record review.

Thirty-two patients (16 males) were 11.6 years old (mean) at the time of operation. Mean follow-up was 26 months. The CCCs were implanted in colon (24), ileum (six) and into a seromuscular colocystoplasty (two). At the last follow up all patients had satisfactory continence through the catheterizable stoma, but the continence rate after the initial procedure was 87.5% (28/32). Three patients required revision because of a short tunnel and became continent. One patient experiences occasional incontinent episodes when the bladder is full, but has not been re-operated on. Three patients experienced difficulties with catheterization attributed to a skin-level stenosis and have been revised. The overall revision rate was 18%.

CCCs constructed with either appendix or transverse tubularized bowel implanted into intestinal segments had a success rate comparable to that reported by others when implanted in the native bladder. The umbilical location of the stoma had significant cosmetic advantages and no apparent disadvantages.