A modified technique of total channel substitution for management of a leaking continent cutaneous catheterizable channel in children: a preliminary report

Background A leaking Continent Cutaneous Catheterizable Channel (CCCC) is a significant and frustrating complication that may need more than one revisional surgery for management. Moreover, some patients are still incontinent after these surgeries. Total channel substitution is required in case of complete disruption of the channel or continence mechanism. However, treatment options are limited. The aim of this study is to illustrate a new outlet mechanism suitable for correcting a leaking CCCC in children. Initially, it was described for urinary conversion in cases of urethral recurrence following radical cystectomy and orthotopic urinary diversion for bladder cancer. Case presentation The proposed technique was performed in two selected cases. The first one was an 11-year-old boy with a diagnosis of neuropathic bladder due to meningomyelocele. He presented with urinary incontinence via the urethra with a leaking CCCC after previous augmentation ileocystoplasty and bladder neck reconstruction with appendicovesicostomy CCCC. The second case was an 8-year-old boy who was a known case of neuropathic bladder post abdominoperineal rectal pull-through surgery for imperforate anus, which was managed by augmentation ileocystoplasty and bladder neck reconstruction with Monti CCCC. He developed a leaking CCCC after a history of traumatic failed catheterization. Total channel substitution was performed using a spiral Monti tube with a serous-lined extramural tunnel continence mechanism via longitudinal opening of only the anterior wall of the pouch. A 6 cm ileal segment was used. No major complications were recorded. At the last follow-up, the channel was still continent with normal upper tract sonographically. Conclusions The proposed technique may be a valuable option for the management of a leaking CCCC in children. It allows the use of a short ileal segment in this challenging cohort of patients. Further prospective studies on a larger number of patients and longer follow-up are recommended.