Techniques Used to Create Continent Catheterizable Channels: A Comparison of Long-term Results in Children

Objective To compare long-term results of 3 different techniques used to create continent catheterizable channels (CCCs) in children in a single institution. Patients and Methods Data were retrospectively collected from 112 children who had a CCC (appendicovesicostomy [APV], tubularized bladder flap [TBF] or Monti) created between December 1995 and December 2013. Primary outcome was revision-free survival. Secondary outcomes were channel stenosis, incontinence, and false channel requiring revision. Time-to-event survival was analyzed using a Kaplan-Meier survival curve. Results A total of 117 CCCs were identified with median follow-up of 85 months. Surgical revision was required in 52%, with no significant difference between the different techniques. Major revision was required in 27% of the cases and significantly more often in Monti channels. Complete revision was required in 7%. Stenosis requiring revision was seen in 33%. A false channel was formed in 9% of the cases. Incontinence with a low leak point pressure was seen in 12%. A time-to-event analysis with a Kaplan-Meier curve showed no significant differences between the 3 techniques. Conclusion Although CCC is an effective solution for children who cannot perform urethral catheterization, 52% requires surgical revision. Because no differences were found in outcome between APV, TBF, and Monti, we conclude that a TBF CCC is a good alternative for the APV. If the appendix is not available and bladder volume is sufficient, a TBF channel is preferred to a Monti channel.