Jeffrey D Redshaw1, Sean P Elliott2, Daniel I Rosenstein3, Bradley A Erickson4, Angela P Presson5, Simon L Conti3, Sean McAdams2, Andrew Nguyen2, Jeremy M West1, William O Brant1, Jeremy B Myers1. 1. Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah. 2. Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota. 3. Department of Urology, Stanford University of School of Medicine, Stanford, California. 4. Department of Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa. 5. Division of Epidemiology, University of Utah, Salt Lake City, Utah.
Abstract
PURPOSE: We compared the outcomes of various adult continent catheterizable channels in a multi-institutional setting. MATERIALS AND METHODS: We retrospectively reviewed the records of all adults who underwent construction of a continent catheterizable channel at our 4 institutions from 2004 to 2013 and who had at least 6 months of followup. Patients were stratified by channel type, including continent cutaneous ileal cecocystoplasty or tunneled cutaneous channel, eg appendicovesicostomy, Monti channel, etc. The primary study outcome was the need for a secondary procedure to correct stomal leakage, catheterizable channel obstruction or stomal stenosis. Secondary outcomes were patient reported leakage and 30-day postoperative complications. We used Firth logistic regression to control for the heterogeneity induced by multiple institutions. RESULTS: A total of 61 patients were included in study, of whom 31 underwent continent cutaneous ileal cecocystoplasty. Mean age was 41.4 years (range 22 to 76). Median followup was 16 months. More patients with a tunneled channel required a secondary procedure than those with cecocystoplasty (15 of 30 or 50% vs 4 of 31 or 13%, OR 6.4, 95% CI 1.8-28). The total number of required secondary procedures was also greater for tunneled channels than for cecocystoplasty (27 vs 4). Of patients with cecocystoplasty 29% reported stomal leakage compared with 43% of those with a tunneled channel (p = 0.12). A high rate of postoperative complications was observed regardless of technique, including 40% for channels and 51.7% for cecocystoplasty. CONCLUSIONS: Patients with continent cutaneous ileal cecocystoplasty undergo fewer interventions to maintain the catheterizable channel than patients with a tunneled continent catheterizable channel.
PURPOSE: We compared the outcomes of various adult continent catheterizable channels in a multi-institutional setting. MATERIALS AND METHODS: We retrospectively reviewed the records of all adults who underwent construction of a continent catheterizable channel at our 4 institutions from 2004 to 2013 and who had at least 6 months of followup. Patients were stratified by channel type, including continent cutaneous ileal cecocystoplasty or tunneled cutaneous channel, eg appendicovesicostomy, Monti channel, etc. The primary study outcome was the need for a secondary procedure to correct stomal leakage, catheterizable channel obstruction or stomal stenosis. Secondary outcomes were patient reported leakage and 30-day postoperative complications. We used Firth logistic regression to control for the heterogeneity induced by multiple institutions. RESULTS: A total of 61 patients were included in study, of whom 31 underwent continent cutaneous ileal cecocystoplasty. Mean age was 41.4 years (range 22 to 76). Median followup was 16 months. More patients with a tunneled channel required a secondary procedure than those with cecocystoplasty (15 of 30 or 50% vs 4 of 31 or 13%, OR 6.4, 95% CI 1.8-28). The total number of required secondary procedures was also greater for tunneled channels than for cecocystoplasty (27 vs 4). Of patients with cecocystoplasty 29% reported stomal leakage compared with 43% of those with a tunneled channel (p = 0.12). A high rate of postoperative complications was observed regardless of technique, including 40% for channels and 51.7% for cecocystoplasty. CONCLUSIONS:Patients with continent cutaneous ileal cecocystoplasty undergo fewer interventions to maintain the catheterizable channel than patients with a tunneled continent catheterizable channel.
Authors: Travis J Pagliara; Ronak A Gor; Daniel Liberman; Jeremy B Myers; Patrik Luzny; John T Stoffel; Sean P Elliott Journal: Can Urol Assoc J Date: 2017-12-22 Impact factor: 1.862
Authors: Jeffrey D Redshaw; Sara M Lenherr; Sean P Elliott; John T Stoffel; Jeffrey P Rosenbluth; Angela P Presson; Jeremy B Myers Journal: BMC Urol Date: 2018-08-29 Impact factor: 2.264