Use of cutaneous flap for continent cystostomy (daoud technique).
OBJECTIVE
We present the results of a new technique using a pedicled cutaneous flap for continent cystostomy.


METHODS
A total of 15 boys and 8 girls (mean +/- SD age 13.4 +/- 6.4 years) underwent continent cystostomy for neurogenic bladder (20), bladder exstrophy (2) and sequelae of hypospadias (1) between 1999 and 2008. In this procedure a rectangular pedicled flap is surgically elevated from a hairless area on the abdomen. The flap is tubularized and passed through the anterior abdominal wall directly into the bladder. A submucosal detrusor incision is made to expose the bladder mucosa, and the distal part of the flap is anastomosed to the bladder mucosa in a circular manner. The tube is positioned along the incised detrusor, which is closed over. Viability of the flap, self-catheterization management and continence status are then evaluated.


RESULTS
Mean +/- SD followup was 4.5 +/- 3.1 years. There was 1 case of distal necrosis of the flap, which required a secondary surgery using the Mitrofanoff technique. The 22 remaining flaps were initially viable, although 2 patients were eventually lost to followup and 3 subsequently presented with false-passage incidents requiring a few days of calibration using a balloon catheter. Dryness was achieved immediately in 73% of the cases. After adding a complementary bulking agent the dryness rate reached 77%.


CONCLUSIONS
We present a novel approach to continent cystostomy that is safe and easy to perform. This technique is a less invasive and more efficient alternative to other commonly used approaches.
Pons
M
M
Pediatric Surgical Unit, CHU Reims, American Memorial Hospital, Reims, France.
Messaoudi
R
R
Fiquet
C
C
Jolly
C
C
Chaouadi
D
D
Lefebvre
F
F
Belouadah
M
M
Bouche-Pillon
M A
MA
Daoud
S
S
Poli-Merol
M L
ML
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003559:Cystostomy / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D013524:Surgical Flaps; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D016476:Urinary Reservoirs, Continent