Survival of intestinal continent or incontinent vesical stomas after transection of the vascular pedicle: a case series.

OBJECTIVE

Intestinal segments are commonly used in reconstructive urology to create continent or incontinent urinary channels. Initially, the viability of these segments depends on the integrity of the vascular pedicle. We report three patients with catheterizable, or incontinent channels constructed using the spiral Monti technique or incontinent ileovesicostomy all of whom developed postoperative complications involving the vascular pedicle.

MATERIAL AND

METHODS

Patients with documented vascular pedicle injury to a continent or incontinent ileovesicostomy in New Children's Hospital, Helsinki University Hospital and in Riley Children's Hospital, Indiana School of Medicine were retrospectively identified and reviewed.

RESULTS

In all three cases, the vascular pedicle was transected either electively or during emergency surgery for intestinal volvulus or obstruction, 17 months to 5 years after reconstructive surgery. Despite pedicle loss, all patients retained viable functional channels, supported by collateral blood supply. Follow-up ranging from several months to 19 years confirmed sustained channel viability.

CONCLUSIONS

These cases suggest that, in select situations, collateral vascularization may be sufficient to preserve the function of a continent stoma despite loss of its primary vascular pedicle.