Serous Lined Extramural Tunnel Principle in the Creation of a Catheterizable Channel in Bladder
Purpose To evaluate the versatility of this principle and its aptness to various situations in pediatric reconstructive surgery providing a video showing the fine technical details. Material and Methods Over the past 9 years, the principle was used in 11 patients (mean age 11years). Indications were: 2 conversions from ileal conduit to continent cutaneous (1 PUV, 1 pelvic rhabdomyosarcoma) and 9 creations of catheterizable channel in bladder augmentation (1 PUV, 3 spina bifida, 5 bladder-exstrophy). Associated procedures were (1 BN closure, 2Sling, 5 Mitchell BNR, 2 MACE). Appendix was used as an outlet in 7 and Monti in 4. Results In all, the stoma was successfully matured to the umbilicus. There were no postoperative complications or difficult catheterization. In the first 3months all were continent. Three-6months later, 3/11(27%) developed secondary incontinence (Injection was tried unsuccessfully). Surgical revisions showed de-ssusception of the tunnel in each (each had Monti outlet). Eight/11(73%) remained continent (mean follow up of 2.4years postoperatively). Conclusions This technique is versatile. Can be used as primary or salvage surgery. The stoma can always be brought to the umbilicus. The appendix is the preferred continent outlet. Fine surgical details as fixation of the outer pouch wall of the tunnel to the inner anterior abdominal wall and the use of interrupted non-absorbable sutures in the tunnel floor are crucial for the success. One disadvantage is that bulking agent injection is not useful to treat secondary incontinence