Difficult-to-Catheterize Continent Channel Revision: Techniques and Outcomes in an Adult Cohort

Continent catheterizable channels allow patients who cannot void volitionally to maintain quality of life. However, catheterizable channels are susceptible to various pathologies, which may necessitate revision. Outcomes after catheterizable channel revision in adults are poorly described and are the focus of this investigation.

We conducted a retrospective review of adult patients undergoing continent catheterizable channel revision at a single institution between 2011 and 2024. Indications for revision included stomal or channel stenosis, redundancy, false passage, and parastomal hernia resulting in difficulty catheterizing. Revisions performed solely for channel incontinence were excluded. Surgeries were categorized by repair type: (1) suprafascial, involving superficial revision with a local skin flap, (2) subfascial, requiring mobilization of the intraperitoneal channel, and (3) channel replacement with a new bowel segment. The primary outcome was freedom from reoperation for recurrent stenosis.

We identified 45 patients who underwent 54 revisions. Common surgical indications were stomal stenosis (24/54, 44%) and channel stenosis (27/54, 50%). Over a median follow-up of 46 months, 41/54 (76%) revisions were successful: 13/19 (68%) for suprafascial revision, 18/20 (90%) for subfascial revision, and 10/15 (67%) for channel replacement (p = 0.178). Eight patients (15%) developed new channel incontinence after surgery; two (4%) developed a parastomal hernia. Study limitations include its retrospective design.

Adult continent catheterizable channel revision can be accomplished with satisfactory success rates. When abdominal entry is necessary for reconstruction, efforts should be made to preserve the existing channel. Patients should be counseled about the risks of de novo stress incontinence and parastomal hernia.