Pd21-08 Outcomes of a Novel Technique for Catheterizable Channel Revision: The Utah Arch

You have accessJournal of UrologyReconstruction: Augmentation, Substitution, Diversion (PD21)1 May 2024PD21-08 OUTCOMES OF A NOVEL TECHNIQUE FOR CATHETERIZABLE CHANNEL REVISION: THE UTAH ARCH Jane T. Kurtzman, Lindsey N. Wright, and Jeremy B. Myers Jane T. KurtzmanJane T. Kurtzman , Lindsey N. WrightLindsey N. Wright , and Jeremy B. MyersJeremy B. Myers View All Author Informationhttps://doi.org/10.1097/01.JU.0001008888.07102.14.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Channel incontinence or stenosis after continent cutaneous urinary diversion is a challenging surgical problem. Up to 30% of patients, depending upon surgical technique, undergo some type of channel revision for incontinence or stenosis. Achieving channel continence with revision is difficult, requiring varied techniques dependent on the original diversion. We present outcomes for our Utah ARCH (Anti-incontinence Reinforced Channel Hitch) method of channel revision. METHODS: We retrospectively identified all patients who underwent channel revisions using the Utah ARCH since its conception in 2019. The key to this method is the creation of Windows of Deaver, avascular tunnels in the mesentery of the channel. A series of horizontal mattress sutures are fixed to the urinary reservoir, then passed through these Windows and into the adjacent reservoir again. When tied, these sutures pull the tissue of the reservoir through the Windows, creating a backboard for the channel. We then bring an 'arch' of plicated reservoir over the channel, which intussuscepts the channel and creates a lengthy and tight extramural serosa-lined flap type valve. RESULTS: A total of 13 patients underwent a revision with the Utah ARCH. Table 1 displays cohort characteristics. Mean follow-up time was 17 months (Median=10, IQR: 1-27). Revisions were performed in 5 different types of pre-existing urinary diversions. Two-thirds of channels were revised for incontinence (n=9) and one-third for stenosis (n=4). Nearly all patients had a secondary procedure performed at the time of revision (n=12). Mean intraoperative blood loss: 169cc; OR time: 295 minutes; and length of stay: 5.8 days range: 3-9. 69% of patients experienced no peri- or postoperative complications: 1 case of postoperative ileus, 2 complications related to the concomitant secondary procedure and 1 ED visit/re-admission within 90 days (surgical site infection). Of patients with follow-up >5 months (n=9), 1 developed a new skin-level stenosis and 1 developed mild incontinence that resolved with injection of a bulking agent. CONCLUSIONS: The Utah ARCH offers a simple, low-risk technique for catheterizable channel revision, applicable to various diversions. Further studies are needed, but the preliminary success rates are promising. Source of Funding: N/A © 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 Jane T. Kurtzman More articles by this author Lindsey N. Wright More articles by this author Jeremy B. Myers More articles by this author Expand All Advertisement PDF downloadLoading ...