The use of an ace Stopper in Catheterisable Channels Virtually Eliminates the incidence of Meatal Stenosis

Abstract

PURPOSE The incidence of meatal stenosis in catheterisable channels (CC) is upto 30% as quoted in the literature. Our aim is to present the effectiveness of an ACE stopper device in preventing such a complication. MATERIAL AND METHODS All cases where CC was created for clean intermittent catheterisation (CIC) over five years from May 2002 were included. Indications included neuropathic bladder, posterior urethral valves and other conditions where CIC was indicated. The exit site of the channels were all skin lined fashioned by either VQZ or VQ plasty. For the first 31 months, the CC were used for CIC but not kept patent in between (group1). Recognising the need to revise stomas in a third of the patients, we began the use of an ACE stopper in the stoma in between CIC for a period of 3-6 months postoperatively for the next 29 months (group2). The two groups were compared for incidence of meatal stenosis. RESULTS A total of 33 CC were included in the study. The CC comprised of 30 Mitrofanoff and 3 Monti channels.There were 19 CC in group1 and 14 CC in group2. CIC occured at 3–4 hour intervals as needed. Size 12 ACE stopper was used in 12 CC and size 10 in 2 CC. The length of the stopper was 60mm in all but one, where a 15mm long stopper was used. In group1, 6 CC (31%) had to be revised within 6 months of reconstruction. In group2, none of the CC had to be revised. This is statistically significant p = 0.02. CONCLUSIONS Our experience shows that without the use an ACE stopper, our complication rates in terms of meatal stenosis of CC occurs in about third of the cases and is similar to figures quoted in literature. However, with the use of an ACE stopper we have had no case of meatal stenosis needing revision of the exit site. An ACE stopper inserted into the CC for 3-6 months effectively eliminates the incidence of meatal stenosis.