Continent catheterisable channels in children: In search of prognostic factors for durable surgical success.

PURPOSE: This study evaluates a 27-year single-center experience with continent catheterisable channels (CCC) to identify factors influencing long-term outcomes.

METHODS

Retrospective review (1998-2025) conducted on patients undergoing CCC placement. Data points analysed included primary diagnosis, surgical indication, conduit type, stoma location, and postoperative complications.

RESULTS

The study included 175 children (99 males) with a total of 178 CCC procedures performed. Primary diagnoses included neuropathic bladder (53%), exstrophy-epispadias complex (21%), complex uropathy (12%), cloacal malformations (7%), and posterior urethral valves (7%). Median age at surgery was 11.3 years (IQR 7.8-14.7). Indications for CCC were concomitant bladder-outlet or reconstructive surgery (46%), difficult urethral catheterization (27%), desire for improved autonomy (21%), and redo surgery (3%). Conduits utilised were appendix (78%), ileum-Casale (9.6%), ileum-Monti (8.4%), and other - sigmoid, vesical flap, ureter (4%). Stoma sites included the right iliac fossa (51%), umbilicus (42%), and other locations (7%). At a median follow-up of 9 years (IQR 4-12), 97% of children maintained channel utility. Complications occurred in 28% of children (n = 48), totalling 70 events: superficial stenosis (9%), suprafascial obstruction (10.7%), subfascial obstruction (7.3%), stomal incontinence (6.2%), and complete channel loss (6.2%). The use of the appendix was associated with lower complication rates (p = 0.03). Stoma location did not significantly impact complication rates.

CONCLUSIONS

Continent catheterisable channels provides durable long-term benefits with high patient utilisation rates. Use of the appendix as a conduit is associated with superior outcomes and fewer complications. Stoma location does not significantly impact complication rates; therefore, site selection should be individualized.