title: Procedures needed to maintain functionality of adult continent catheterizable channels: a comparison of continent cutaneous ileal cecocystoplasty with tunneled catheterizable channels.
abstract: OBJECTIVE
  We compared the outcomes of various adult continent catheterizable channels in a multi-institutional setting.
  
  
  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.affiliation: Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Redshaw
authors.affiliation: Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Elliott
authors.affiliation: Department of Urology, Stanford University of School of Medicine, Stanford, California.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Rosenstein
authors.affiliation: Department of Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Erickson
authors.affiliation: Division of Epidemiology, University of Utah, Salt Lake City, Utah.
authors.forename: Angela P
authors.initials: AP
authors.lastname: Presson
authors.affiliation: Department of Urology, Stanford University of School of Medicine, Stanford, California.
authors.forename: Simon L
authors.initials: SL
authors.lastname: Conti
authors.affiliation: Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Sean
authors.initials: S
authors.lastname: McAdams
authors.affiliation: Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Andrew
authors.initials: A
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: West
authors.affiliation: Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: William O
authors.initials: WO
authors.lastname: Brant
authors.affiliation: Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Myers
mesh_terms: D000328:Adult; D000368:Aged; D002432:Cecum / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D054047:Surgical Stomas; D001743:Urinary Bladder / Q000601:surgery*; D014546:Urinary Catheterization; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult
keywords: catheterization; complications; reoperation; surgical stomas; urinary diversion