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Continent catheterizable conduits in pediatric urology: One-center experience
Paweł Kroll1,2,3, Ewa Gajewska4, Jacek Zachwieja3
1Department of Pediatric Surgery, Poznan University of Medical Sciences, Poland.
Summary
Continent catheterizable conduits (CCCs) effectively achieve urinary and fecal continence in children. Procedures like Mitrofanoff and Malone antegrade continence enemas (MACE) demonstrate high success rates with minimal complications.
Area of Science:
- Pediatric Surgery
- Urology
- Gastroenterology
Background:
- Clean intermittent catheterization (CIC) is standard for bladder emptying issues.
- Continent catheterizable conduits (CCCs) offer an alternative when urethral catheterization is problematic.
- The Malone procedure is a key treatment for pediatric neurogenic constipation and fecal incontinence.
Purpose of the Study:
- To evaluate the authors' experience with CCCs in children.
- To assess the efficacy of CCCs, focusing on continence and revision rates.
- To review outcomes of Mitrofanoff and Malone procedures in pediatric patients.
Main Methods:
- Retrospective analysis of 115 children undergoing CCC procedures (2000-2015).
- Procedures included Mitrofanoff vesicostomies (n=62) and Malone appendicostomies (n=72).
- Laparoscopic techniques were used for 27 Malone procedures; some combined Mitrofanoff and Malone procedures.
Main Results:
- Mean follow-up was 8.6 years with no serious morbidity.
- 59 of 62 children with catheterizable vesicostomies achieved continence.
- All 72 patients undergoing MACE resolved constipation and fecal incontinence issues.
Conclusions:
- CCCs are effective for achieving both fecal and urinary continence in pediatric patients.
- Laparoscopic Malone procedures are effective and safe.
- End-to-side appendix anastomoses may prevent stoma complications; stomal incontinence is rare.
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