title: 20 years experience with appendicovesicostomy in paediatric patients: Complications and their re-interventions.
abstract: OBJECTIVE
  To evaluate the long-term outcome of appendicovesicostomies and to present the frequency and timing of complications needing re-intervention.
  
  
  METHODS
  In this retrospective study we included patients in whom an appendicovesicostomy was created at our institution between 1993 and 2011. Patients with a follow-up less than 1 year were excluded. Patient characteristics and conduit-related complications requiring re-intervention were collected.
  
  
  RESULTS
  One hundred and twenty-eight patients were included with mean age at initial surgery of 10.1 ±  3.9 years. Two thirds of the children had underlying neurogenic disease. The mean follow-up was 10.1 ± 4.8 years. All but one patient continued to use the catheterizable channel. Re-intervention for conduit-related complications was necessary in 32.0% of the patients. A second, third, and fourth re-intervention was required in respectively 10.9%, 2.3%, and 1.6%. The commonest complications were cutaneous/fascial stenosis in 14.8%, stenosis at conduit-bladder level in 9.4%, and stomal incontinence in 6.3% of the patients. The most performed re-interventions were stoma revision (in 16.4% of the patients), conduit revision (10.2%), and dilatation of a stenotic tract (4.7%). 63.3% of the re-interventions was superficial and/or endoscopic. The peak incidence of re-interventions was in the 1st year after conduit construction and decreased yearly.
  
  
  CONCLUSIONS
  Our study gives an overview of patients and their conduits developing from prepubertal children to young adults. During a mean follow-up of 10.1 years, roughly one third of the patients needed a re-intervention. We conclude that an appendicovesicostomy is an effective and durable treatment for whom transurethral clean intermittent catheterization is not feasible. Neurourol. Urodynam. 36:1325-1329, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Sarah H M
authors.initials: SHM
authors.lastname: Reuvers
authors.affiliation: Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Joop
authors.initials: J
authors.lastname: van den Hoek
authors.affiliation: Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Bertil F M
authors.initials: BFM
authors.lastname: Blok
authors.affiliation: Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Telma C
authors.initials: TC
authors.lastname: de Oliveira Barbosa
authors.affiliation: Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Katja P
authors.initials: KP
authors.lastname: Wolffenbuttel
authors.affiliation: Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Jeroen R
authors.initials: JR
authors.lastname: Scheepe
mesh_terms: D000293:Adolescent; D001065:Appendix / Q000601:surgery*; D002648:Child; D003559:Cystostomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057928:Intermittent Urethral Catheterization; D059411:Lower Urinary Tract Symptoms / Q000601:surgery*; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent
keywords: adolescence; complications; continent catheterizable conduit; continent urinary reservoir; long-term effects; urinary diversion