Reoperation for Channel Complications in Children With Continent Cutaneous Catheterizable Channels: The Test of Time
| Autor: | Helmy Omar, Tamer E. Helmy, Mohamed E. Dawaba, Ahmed S. El-Hefnawy, Mohamed Edwan, Ahmed Abdelhalim, Ashraf T. Hafez |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Urology Umbilicus (mollusc) Urinary system medicine.medical_treatment Appendix Stoma Postoperative Complications medicine Humans Child business.industry Urinary diversion Urinary Reservoirs Continent Plastic Surgery Procedures Surgery Cystostomy medicine.anatomical_structure Outcome and Process Assessment Health Care Urinary Incontinence Urologic Surgical Procedures Female Complication business Urinary Catheterization Follow-Up Studies |
| Zdroj: | Urology. 159 |
| ISSN: | 1527-9995 |
| Popis: | To examine the durability of continent cutaneous catheterizable urinary channels (CCCC) in children and assess whether channel complications continue to arise with extended follow-up. Previous studies demonstrated that complications of CCCC cluster in the early years following surgery.The database of a tertiary center was queried for patients≤21 years who underwent CCCC. Patients with6 years of follow-up were excluded. Patients were invited for follow-up to assess continence. Clinic visits and hospital admissions were reviewed for channel complications requiring reoperation. Complications were analyzed against patient and channel characteristics and time since initial surgery.Between 1993 and 2012, a total of 120 patients underwent CCCC at a median age of 6.8(0.4-21) years and a median follow-up of 11.4(6.6-27) years. CCCC were created using the appendix, Monti channels and tapered ileal segments in 74(61.7%), 33(27.5%) and 13(10.8%), respectively. Continence relied on the extra-mural serous lined principle in 85.8% and the stoma was anastomosed to the umbilicus in 90%. Dryness with catheterization intervals of 3 hours or longer was eventually achieved in 90.8% with similar rates among different channel types (P=.149). 26(21.7%) required 42 interventions to treat channel complications with 32.5% occurring5 years following initial surgery irrespective of the channel type (P=.978). On multivariate analysis, ileal channels had 3.372 higher odds of needing reoperation compared to appendicovesicostomy (95%CI=1.240-9.166; P = .037).A high reoperation rate is anticipated throughout the lifetime of CCCC. Appendicovesicostomy has a low complication risk relative to ileal channels. |
| Databáze: | OpenAIRE |
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