The utilization of a spare ureter to create a continent catheterizable channel to the bladder in pediatric patients

Abstract

Introduction

Clean intermittent catheterization (CIC) has significant advantages over indwelling catheters. To facilitate CIC, a continent catheterizable channel (CCC) to the bladder is required in some cases. The Mitrofanoff appendicovesicostomy (APV) is considered the gold standard for pediatric CCC creation. However, when the appendix is unavailable or unsuitable for the creation of a CCC alternatives are required.

Objective

This study aims to share our single-center experience with using a spare ureter as a CCC in pediatric patients and compare its advantages and complications to those of APV and the use of bowel segments.

Study design

A retrospective review of the medical records of all pediatric patients who underwent CCC creation between 2001 and 2023 was performed. The inclusion criteria were age younger than 18 years at surgery and the use of an appendix, ileal segment, or ureter for CCC creation.

Results

A total of 108 pediatric patients underwent CCC creation. Of these, 90 had an APV, 5 had an ileal segment CCC, and 13 had a ureteral CCC. Operating times were not significantly different among the groups. The median follow-up was 78 months for the ureter group, 66 months for the APV groups and 13 months for the ileal group. The stomal continence rates were 92 % for the ureter group, 97 % for the APV group, and 100 % for the ileal group. Stomal complications occurred in 15.4 % of ureter CCCs, 25.6 % of APVs, and 40 % of ileal CCCs. No significant differences in complication rates were observed among the groups.

Discussion

Our findings demonstrate that ureteral CCCs have acceptable complication rates and functional outcomes comparable to those of APVs and ileal CCCs. The limitations of this study include its retrospective design and small sample size, especially in the ureteral and ileal groups. Future prospective studies with larger cohorts are recommended to further validate these findings.

Conclusion

Our study indicates that the utilizazion of a spare ureter for CCC creation is a feasible and effective alternative in pediatric patients with a nonfunctioning kidney.