Pd21-07 Hemi-Kock Ileal Continent Catheterizing Channel in Patients With Adverse Risk Factors

You have accessJournal of UrologyReconstruction: Augmentation, Substitution, Diversion (PD21)1 May 2024PD21-07 HEMI-KOCK ILEAL CONTINENT CATHETERIZING CHANNEL IN PATIENTS WITH ADVERSE RISK FACTORS Sender Herschorn, Sarah Neu, and Rano Matta Sender HerschornSender Herschorn , Sarah NeuSarah Neu , and Rano MattaRano Matta View All Author Informationhttps://doi.org/10.1097/01.JU.0001008888.07102.14.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The management of patients with severely reduced capacity bladders and other risk factors who opt for continent catheterizing channels (CCC) is challenging. A cohort of patients with adverse factors who underwent Hemi-Kock (HK) CCC was analysed for outcome, durability, and revision rate. METHODS: 34 patients (22 women, 12 men) with a mean age of 39.5 years (18-72) were selected from a total of 117 patients who underwent HK CCC. Adverse factors included pelvic radiation (5), multiple unsuccessful appendiceal or Monti Mitrofanoff revisions (9), bladder capacity ≤75mL (20). Diagnoses were spinal cord injury (12), spina bifida (9), other neurological (4), exstrophy (2), post-radiation (5), pelvic trauma (1), post SUI surgery (1). Preoperative management was foley in 20, suprapubic in 6, intermittent catheterization (IC) and pads in 8. In addition to the intussuscepted ileal nipple valve adjacent ileal cystoplasty was done in 32 and sigmoid cystoplasty in 2. Simultaneous urethral procedures included bladder neck (BN) slings in 12, BN closure in 12. Outcomes were from a prospectively collected database and included durability, complications, and reinterventions. Success was defined as persistence of IC with social continence. RESULTS: Mean follow-up was 9.5 years (median 6.5), (range 0.2 to 32.5). Overall bladder capacity increased significantly (mean 112 mL to 517 mL) (p<0.0001). At last follow-up 30/34 patients (88%) were managing with IC±pads. 4 were failures including 2 with indwelling catheters and 2 required ileal conduits. Ten patients (29%) required open surgical reinterventions including 2 for early postoperative complications of intra-abdominal urine leak (1) and wound dehiscence (1). 3 patients (8.8%) required parastomal hernia repairs, 1 (3%) required stomal revision, 3 (8.8%) required valve revisions and 2 had ileal conduits (one of whom had previous reintervention). Bladder stones seen in 15 patients (44%) were managed cystoscopically through the native urethra or CCC under local anaesthesia. 12 patients (35%) have not required any further intervention. 5 patients died from unrelated causes, 1 post-radiation from pelvic sepsis despite secondary cystectomy 4 years after the procedure, and 1 from urothelial cancer after 15 years. 1 woman had a full-term pregnancy. Re-interventions may be needed years after the original procedure. No other significant morbidity has been seen. CONCLUSIONS: HK CCC has good durability in patients with adverse risk factors. Having a large CCC and leaving urethral access, if possible, facilitates subsequent endoscopic procedures, if required. Long-term follow-up is needed. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e456 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sender Herschorn More articles by this author Sarah Neu More articles by this author Rano Matta More articles by this author Expand All Advertisement PDF downloadLoading ...