PD11-06 DURABILITY OF REVISION SURGERY FOR STENOSIS OF CATHETERIZABLE CHANNELS IN ADULTS

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion II1 Apr 2015PD11-06 DURABILITY OF REVISION SURGERY FOR STENOSIS OF CATHETERIZABLE CHANNELS IN ADULTS Travis Pagliara, Daniel Liberman, Jeremy Myers, John Stoffel, and Sean Elliott Travis PagliaraTravis Pagliara More articles by this author , Daniel LibermanDaniel Liberman More articles by this author , Jeremy MyersJeremy Myers More articles by this author , John StoffelJohn Stoffel More articles by this author , and Sean ElliottSean Elliott More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1095AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of stenosis of continent catheterizable channels varies by channel type (e.g. Mitrofanoff vs. Monti vs. tapered ileal limb) and patient factors. Up to 55% of channels will require intervention for stenosis; intervention is usually a dilation but for recurrent stenosis revision surgery may be required. We sought to describe the strategies of surgical revision for catheterizable channel stenosis and their outcomes. METHODS We retrospectively reviewed the charts of 74 adult patients who underwent catheterizable channel revision or replacement from 2000 to 2014 for stomal stenosis or difficult catheterization. The primary outcome was continued ability to catheterize the channel post-operatively without surgical dilation or revision. Secondary outcomes included channel continence and post-operative complications. Revisions were classified into the following strategies: revision above the rectus fascia, below the fascia, or channel replacement. RESULTS Revision approaches included 42% above the fascia, 30% below the fascia, and 28% channel replacement. Patients with congenital etiology of neurogenic bladder were more likely than other patients to undergo more complicated revisions (p=0.012). Channel patency was achieved in 65% at a median 34 months post-revision procedure; there was no difference by revision strategy (p=0.104). Severe stomal incontinence occurred in 3.2% after above the fascia repairs, 22.7% after below the fascia repairs and 14.3% after channel replacement (p=0.111). Surgical complications occurred in 28.4%; almost all were Clavien 1-2 and there was no difference by revision strategy (p=0.293). CONCLUSIONS Surgical revision for continent channel stenosis can be performed with good rates of durable patency. Patency rates are similar across surgical strategies of revision. Those with congenital neuropathic bladder require more complex revisions. Severe post-operative channel incontinence is not uncommon. We present our management algorithm based on length of stenosis, the amount of redundant channel available for reconstruction, and the presence or lack of a continence mechanism prior to intervention (Figure 1). © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e253 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Travis Pagliara More articles by this author Daniel Liberman More articles by this author Jeremy Myers More articles by this author John Stoffel More articles by this author Sean Elliott More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...