INTRODUCTION AND OBJECTIVES: Creation of a continent catheterizable channel (CCC) has dramatically changed the management of patients undergoing lower urinary tract reconstruction. As many interventions are carried out during childhood it is particularly important to look at long-term problems due to the inherent life expectancy of this population. Herein we present outcomes and complications on a single-center series followed up to 15 years.

METHODS: Medical records of all children who underwent CCC (Mitrofanoff and Monti) between 1992 and 2007, regardless of indication for surgery, were retrospectively reviewed. Data were systematically collected for the following variables: Age, underlying diagnosis, associated procedures, stoma site, tissue used for creating of the conduit (appendix or reconfigured bowel), time to complications (stenosis, prolapse, incontinence) and need for revision.

RESULTS: At a mean age of 7.5 years (6m-22yrs.), 71 girls and 98 boys were evaluated, with a subsequent follow-up of 5.8 years (8m-15y). Underling diagnosis included neurogenic bladder (36%), bladder exstrophy (25%), epispadias (7%) and rhabdomyosarcoma in (5%). Concurrent procedures (bladder augmentation, 35%; bladder neck plasty, 22%; bladder neck closure, 8%) were done in 71% of cases. The overall complication rate was 39% (stenosis/stricture, 25%; incontinence, 10%; prolapse, 4%). Even though an initial peak was followed by a stable complication-free period, on long-term follow delayed problems were detected (Fig. 1). Most CCC (96%) were functional at last f/u including 8% in which the channel could not be salvaged and had to be recreated. On a time-to-event analysis no statistically significant differences in complications rates comparing use of appendix vs. Monti CCC, underlying diagnosis, age or stoma position were noted.

CONCLUSIONS: Complications after CCC appear to decrease over time but late problems are detected on long-term evaluation. In our experience no factors predicted likelihood of complication. At long-term follow-up good outcomes were encountered despite need for revision.

Source of Funding: none