Continent Catheterizable Channels
Authors:   , Polm Pepijn Dione 
Published: September 2024

This thesis comprises several studies on the prevalence of complications during long-term follow-up of continent catheterizable channels (CCCs) and urinary diversions. In order to facilitate clean intermittent catheterization (CIC), a CCC can be created. Prior to this thesis, a notable gap in the literature was the lack of comparative studies evaluating the different CCC techniques (appendicovesicostomy (APV), ileal segment channel (ISC) and tubularized bladder flap (TBF)).
We performed a retrospective study and included 117 created in children with a median follow-up of 7.1 years. This study showed a surgical revision rate of 52% of all CCCs, with no significant differences between the three channel types.
Another study included adult patients with a CCC (173 CCCs, 12.4 years follow-up). In this cohort we found a notable different surgical revision rate between ISC (2/3 required revision) and AVS/TBF (nearly half required revision).
The lack of significant differences in long-term complication rates between TBF and AVS in our studies led to the increased use of TBF in the adult population at the functional urology department of UMC Utrecht. In selected patients, the option of TBF was discussed as the preferred option during preoperative counseling. The potential advantage of this technique being the avoidance of intraperitoneal surgery and bowel manipulation, hypothetically leading to a lower risk of postoperative paralytic ileus, anastomotic leakage or stenosis.
This hypothesis was further investigated in a study cohort of 11 adult patients in whom a TBF was created with good post-operative results. At the last follow-up, more than 80% of the TBF CCCs were functioning well with no reported stomal incontinence.
Another study in this thesis is about long-term complications of the Indiana Pouch. We analyzed complications in a cohort of 33 patients with an IP with a median follow-up of more than 20 years. The estimated mean revision-free survival was 198 months, indicating that the Indiana Pouch is a durable and well-functioning continent urinary diversion for a significant proportion of patients. However, complications may occur even after many years, sometimes subclinically, highlighting the need for structured lifelong follow-up.
Patients with urinary diversion are known to be at risk of deteriorating renal function due to their underlying diagnosis or as a result of reconstructive surgery. In a retrospective cohort, proteinuria was not associated with renal function or decline in renal function over time. These findings highlight the limitations of proteinuria screening to identify patients with urinary diversion at risk of renal decline.
In an attempt to better understand the continence dynamics within a CCC, we investigated the feasibility of extending the standard urodynamic test to include measurement of pressures within the lumen of the CCC to generate a stomal pressure profile. We found that it is feasible to do so and found differences in pressure profiles between patients with and without leakage, suggesting a role for the intravesical tunnel in stomal continence.