Outcomes of continent catheterizable stomas for urinary and fecal incontinence: comparison among different tissue options.
ABSTRACT To retrospectively review the outcome of appendix, transverse tubularized intestine segments, caecal flap, gastric tube and others tissue options used as a continent stoma for urinary and fecal incontinence.
Between January 1993 and January 2003 we created 179 continent stomas to treat urinary and fecal incontinence in 135 patients (81 females and 54 males; mean age at surgery 13 years, 118, 87%, aged <17 years). We used either appendix (112), a short segment of bowel following the Yang-Monti technique (49), gastric augment single pedicle tube (eight), caecal flap (seven), Casale continent vesicostomy (two) and Meckel's diverticulum (one). Thirty-six patients had both urinary and fecal continent stomas created.
The mean follow-up for the appendix group was 46 months for the urinary stoma and 23 months for the Malone antegrade continent enema (MACE) stoma. Stoma-related complications occurred in 24 of 112 (21%) patients; there was complete channel fibrosis in five (4%). The mean follow-up for the Yang-Monti group was 38 months for the urinary and 59.2 months for the MACE stoma. There were stoma-related problems in 11 of 49 (22%) patients, with complete channel fibrosis in three (6%). Overall, in the long-term follow-up, there were stoma-related complications in 42 of 179 (23.5%) procedures.
Continent catheterizable stomas are a feasible and reliable method for treating urinary and fecal incontinence. Long-term success can be accomplished with appendix, transverse tubularized intestinal segments and caecal flaps, with similar complication rates in all groups. Surgeon preference and individual patient status should determine the surgical technique to be used.
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ABSTRACT: The comfort obtained in some cases of neurogenic bladder of the girl, thanks to unsterile self catheterization, and usual absence of septic complications, incite to search for a process which could be used for the boys as well as girls in those cases where urethral catheterization cannot be done. What's more, if the catheterization is easy to achieve even by young children and if the process brings complete dryness, almost perfect conditions of comfort would be achieved. A cystostomy with a continent opening easy to catheterize and associated with a closure of the vesical neck, was the objective. We had the idea to use the appendix in order to create a passage between the skin and the bladder, the tip of the appendix opening into the bladder at the end of an anti-reflux submucosal tunnel and the other end hemmed to the skin. The bladder neck is usually closed in the course of the same operation. From October 1976 to January 1979, 16 children have gone through such a vesicostomy. In two more cases a trans-ureteral cystostomy was created. Five cases were a failure owing to a too small bladder and required a cutaneous diversion. The continence of the vesicostomy is total and the comfort obtained is excellent for the other 13 cases. Some complications result directly from this technique. It concerns more particularly cutaneous fistula (1 case) or with urethral repermeation (2 cases). Other problems, common to all conservative treatments of a neurogenic bladder, are discussed:vesico-renal reflux, dilatation of the upper urinary tract, urinary infections and of course, risk for the renal function. They appear to be related with a small and hypertonic bladder. Obviously these problems must be kept in mind and require a strict selection for the vesicostomy and a strict followup.Chirurgie pédiatrique 02/1980; 21(4):297-305.
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ABSTRACT: Since 1990 we have used stomach for bladder augmentation and continent urinary diversions in 73 patients, of whom 15 received a gastric tube catheterizable stoma and are the subject of this report. The gastric tube receives its blood supply from the same vascular pedicle as the gastric patch and, therefore, it can be moved anywhere along with the patch. The tube is then reimplanted in the reservoir or bladder following the Mitrofanoff principle and brought to the skin as a catheterizable stoma. Patient age ranged from 12 to 60 years. Three patients underwent augmentation cystoplasty and 12 received a composite gastrointestinal continent reservoir (in 10 a prior bowel conduit was detubularized and used as part of the reservoir). The appendix was either previously removed (10 patients) or not suitable as a catheterizable limb (4). All patients are continent. Catheters used to empty the reservoir varied from 12F to 18F. Complications included an early traumatic perforation of the tube in 1 patient, distal stenosis in 1 and mucosal redundancy in 1. Of these patients 2 required revision. Two patients had mild peristomal skin irritation without ulceration. Anatomical and technical aspects of this procedure are presented. In summary, we believe the gastric augment single pedicle tube to be a useful tool for the reconstructive urologist, which in select cases may obviate the need for additional bowel anastomosis to create a tapered intestinal catheterizable limb.The Journal of Urology 01/1995; 152(6 Pt 1):2005-7. · 3.70 Impact Factor
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ABSTRACT: The successful use of stomach for bladder augmentation and substitution is well documented. Gastric tissue has been used more recently to create continent catheterizable tubes. We describe 2 new techniques of gastric tube construction, and report our long-term followup of catheterizable gastric tubes in children and adults undergoing complex urinary tract reconstruction. A retrospective chart review of 6 male and 4 female patients 5 to 43 years old was done. Primary diagnoses included bladder exstrophy, cloacal exstrophy, rhabdomyosarcoma and neurogenic bladder. Five patients underwent gastrocystoplasty with simultaneous creation of a continent gastric tube from the anterior gastric flap. In 2 patients who had undergone previous gastrocystoplasty a continent gastric tube was created from an anterior flap raised from the existing gastric bladder. Isolated gastric tubes were constructed in 3 patients. Followup ranged from 2 to 9 years (median 3.5). All patients demonstrated easy reliable catheterization. One patient required revision of the proximal end of the tube for incontinence. At followup all tubes were continent. Complications occurred only in flush or protuberant stomas, and resolved after stomal revision with recessed skin flaps. Several techniques can be used to create a continent gastric tube. Long-term followup reveals reliable catheterization and good continence rates. Recession of the gastric tube stoma with a skin flap prevents peristomal complications.The Journal of Urology 02/1997; 157(1):51-5. · 3.70 Impact Factor