Clean intermittent catheterization (CIC) is a standard treatment for patients who are unable to empty the bladder. In the absence of the urethra or if catheterization through the urethra is problematic, a continent vesicostomy is used as a catheterizable conduit. The Malone procedure is an established treatment option for children with neurogenic constipation and fecal incontinence.
The aim of the study was to report the authors' experience with continent catheterizable conduits (CCCs) in children, to review the results and to determine the efficacy of the technique, with an emphasis on continence and the need for revision.
The retrospective study involved children who underwent catheterizable conduit procedures from 2000 to 2015. Two kinds of continent stomas were performed: Mitrofanoff vesicostomies for CIC and Malone antegrade continence enemas (MACEs). The 115 patients treated included 66 girls and 49 boys. A total of 134 operations were performed; 62 were Mitrofanoff vesicostomies and 72 were Malone appendicostomies. In 19 cases, both Mitrofanoff and Malone appendicostomies were formed out of 1 appendix divided into 2 parts. In 5 children vesicocutaneous stomas were constructed using Monti's procedure, and in 1 it was constructed from an intussuscepted ileal loop. In 27 patients Malone procedures were performed laparoscopically.
The mean follow-up period was 8.6 years. There was no serious morbidity in relation to the surgery. In 9 children local wound infection was noted, and in 9 others stomal stenosis developed. Out of the 62 children with catheterizable vesicostomies, 59 were continent. The MACE procedure was successful in all 72 patients; problems with constipation and fecal incontinence were resolved in all cases. None of the laparoscopies needed conversion.
Continent catheterizable conduits help patients achieve both fecal and urinary continence. Laparoscopy is effective in performing the Malone procedure. Stoma-related complications could be avoided using end-to-side appendix anastomoses to the skin. Stomal incontinence is rare even when a simplified technique is employed, using the appendix without cecoplication.
Advances in clinical and experimental medicine : official organ Wroclaw Medical University. 2017 Oct [Epub]
Paweł Kroll, Ewa Gajewska, Jacek Zachwieja, Danuta Ostalska-Nowicka, Maciej Micker, Andrzej Jankowski
Department of Pediatric Surgery, Poznan University of Medical Sciences, Poland., Department of Rehabilitation, Faculty of Physical Culture in Gorzów Wielkopolski, University School of Physical Education in Poznań, Poland., Neurology Unit, Poznan University of Medical Sciences, Poland., Pediatric Nephrology Department, Poznan University of Medical Sciences, Poland., Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poland.