Long-term multi-institutional evaluation of Charleston pouch I continent cutaneous urinary diversion.
OBJECTIVE
Charleston pouch I continent cutaneous urinary diversion has been used since 1989. We evaluated the long-term results of this procedure in 201 consecutive patients.


METHODS
The records of patients treated with the Charleston pouch I between 1989 and 2005 at 3 university hospitals were reviewed. Available data on age, sex, indications for diversion, comorbidity, followup duration, continence status, short-term and long-term complications, quality of life issues, and laboratory, radiological and urodynamic data were recorded. Patients were followed at 6-month intervals.


RESULTS
Followup was 14 to 136 months. Seven adults died in the 90-day postoperative period, and 21 (10.8%) and 51 (26%) patients had early and late complications, respectively. The interval between clean intermittent catheterizations was 2 to 8 hours. Mean capacity was 470 ml (range 250 to 1,300). At 12 months diurnal continence was achieved in 98% of the patients. A total of 98 patients (50.5%) needed night catheterization to stay dry. Of 342 ureters 17 (5%) became obstructed, requiring open or endoscopic management. Urolithiasis developed in 16 patients (8%). Vesicoureteral reflux was noted in 15 renal units (4.4%). Stomal complications developed in 8.2% of cases. Modest vitamin B12 supplementation was empirically used to avoid long-term deficiency. No detrimental effects on vitamin B12 concentrations were noted for up to 10 years.


CONCLUSIONS
Long-term multi-institutional followup of the classic Charleston pouch I reveals that it provides adequate continence with an acceptable complication rate and satisfactory patient acceptance.
Abdallah
M M
MM
University of Arkansas for Medical Sciences, Arkansas Children Hospital, 4301 W. Markham Street, Little Rock, AR 72205, USA.
Bissada
N K
NK
Hamouda
H M
HM
Bissada
A N
AN
D000293:Adolescent; D000328:Adult; D000368:Aged; D001065:Appendix / Q000601:surgery*; D002648:Child; D003106:Colon / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000601:surgery*; D014546:Urinary Catheterization; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*