Continent catheterizable channels: Does "hitching" the bladder reduce complications?

Background: Continent catheterizable channels (CCC) are a mainstay for reconstruction in patients with neurogenic bladders. Common complications include false passage, channel stenosis/difficult catheterization, channel incontinence, and stomal stenosis. This may result in the need for surgical revision or replacement. It has been suggested that stabilization of the bladder to the anterior abdominal wall or "hitching" can reduce complications, but evidence is lacking.

Objective: Review our single institution experience with CCCs to determine if "hitching" the bladder reduced complications.

Study design: A retrospective, single-institution cohort study of patients with CCC to the bladder created between 2/2005-6/2019 was performed. Patients whose channel was implanted into augmented bowel and those with <6 months of follow-up after channel creation were excluded. The cohort was further divided into 2 groups: those that were done with "hitching" and those without. Complications, including subfascial revision for difficulty with catheterization, channel incontinence (leakage despite favorable bladder dynamics and adherence to clean intermittent catheterization), and stomal stenosis, were compared between the groups using Cox proportional hazards regression.

Results: There were a total of 109 patients with CCC created during our study period. Four channels tunneled into augmented bowel were excluded. Median follow up was 5.8 (IQR 3.5-8.3) years. A total of 21/105 (20 %) channels were hitched to the abdominal wall during surgery. There were no significant differences in demographics, surgical characteristics, diagnoses, or channel types in the hitched versus non-hitched groups. The overall rate of subfascial revision or need for channel replacement due to difficulty with catheterization was 9/105 (8.6 %). The rate of revision or replacement was 1/21 (4.8 %) in the hitched group versus 8/84 (9.5 %) in the non-hitched group (p = 0.68). The overall channel incontinence rate was 3/105 (2.9 %). The rate of channel incontinence was 0/21 (0 %) in the hitched group versus 3/84 (3.6 %) in the non-hitched group (p = 1.0). The overall stomal stenosis rate was 23/105 (21.9 %) with 5/105 (4.8 %) going on to a stomal-level surgical revision. The rate of stomal revision for stenosis was 1/21 (4.8 %) in the hitched group versus 4/84 (4.8 %) in the non-hitched group (p = 1.0). Survival analyses indicated no statistically significant differences in time to complications and revisions between hitched and non-hitched groups.

Conclusion: Routine "hitching" of the bladder to the abdominal wall with CCC does not appear to reduce complications or the need for future surgical revision compared to not hitching the bladder.