title: Clean intermittent catheterization in children through a continent catheterizable channel: a developing country experience.
abstract: OBJECTIVE
  We evaluated the role of clean intermittent self-catheterization through a continent catheterizable Mitrofanoff channel in an augmented bladder in children with bladder dysfunction and outlet obstruction.
  
  
  METHODS
  We retrospectively analyzed the records of 82 patients treated at a public sector hospital with pediatric urology services in a developing country. Patients came from all provinces of the country with diverse ethnic, cultural, linguistic, socioeconomic and educational backgrounds.
  
  
  RESULTS
  Mean +/- SD patient age was 9.07 +/- 3.38 years (range 2.5 to 15) with a male-to-female ratio 2.5:1.0. The main congenital and acquired abnormalities were posterior urethral valves in 29% of patients, neuropathic bladder in 22%, nonneurogenic neurogenic bladder in 17%, exstrophy plus epispadias in 10% and urethral stricture in 7%. Augmentation cystoplasty was performed using various bowel segments. The Mitrofanoff channel was made using appendix in 70 cases and by the spiral Monti method in 12. A stoma was created in the right iliac fossa using VQZ plasty in 72 patients and an umbilical stoma was created in 10. Complications included bladder calculus in 3 patients, stomal stenosis in 2, subacute intestinal obstruction in 4 and acute intestinal obstruction in 1. Compliance was observed in greater than 90% of the patients at a mean followup of 860 days.
  
  
  CONCLUSIONS
  In a developing country setting with a low socioeconomic and educational level it is possible to successfully perform augmentation cystoplasty with clean intermittent self-catheterization through a continent catheterizable channel in children with bladder dysfunction and outlet obstruction. The active role of pediatric urologists in the care, teaching and counseling together with free care to all are the reasons for acceptance and compliance.
authors: Department of Urology, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan.
authors: Sajid
authors: S
authors: Sultan
authors: Ijaz
authors: I
authors: Hussain
authors: Bashir
authors: B
authors: Ahmed
authors: Sadaf
authors: S
authors: Aba Umer
authors: Sharjeel
authors: S
authors: Saulat
authors: S A Anwar
authors: SA
authors: Naqvi
authors: S Adibul Hasan
authors: SA
authors: Rizvi
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D010154:Pakistan; D012189:Retrospective Studies; D054047:Surgical Stomas; D014521:Urethra / Q000002:abnormalities; D001743:Urinary Bladder / Q000601:surgery; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery* / Q000628:therapy; D001750:Urinary Bladder, Neurogenic / Q000601:surgery* / Q000628:therapy; D014546:Urinary Catheterization