Long-term usage pattern and satisfaction survey of continent catheterizable channels

Published:October 29, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.10.017

      Summary

      Introduction

      We investigated the long-term usage pattern and satisfaction of continent catheterizable channels (CCCs).

      Methods

      From 2005 to 2018, CCCs, including Mitrofanoff and antegrade continent enema (ACE) channels, were made in 67 patients (Mitrofanoff in 21 patients, ACE channels in 43 patients, and both in three patients) in our institution. An online survey was conducted for these patients in order to assess usage pattern, continent status, difficulty in usage, and patient satisfaction.

      Results

      Sixteen (66.7%) out of 24 patients with the Mitrofanoff channel and 39 (84.7%) out of 46 patients with the ACE channel completed the online survey. In the Mitrofanoff channel group, 10 (62.5%) patients had spina bifida, two (12.5%) had Hinman syndrome, one (6.3%) had posterior urethral valves, and three (18.8%) had urethral trauma or atresia. Additionally, the mean age of the patients at the time of surgery was 10.0 years, and the median follow-up duration was 10.9 years. All patients were using the Mitrofanoff channel to perform clean intermittent catheterization (CIC). Eleven patients (68.8%) had difficulty with catheterization, mostly at the stomal site. Most patients conducted CIC more than four times a day (13, 81.3%). Regarding urination status, seven patients (43.8%) responded that they were satisfied and nine (56.2%) responded they were neutral. In the ACE channel group, 35 patients (89.7%) had spina bifida, seven (17.9%) had cloacal anomalies, and 26 (66.7%) had anorectal malformations. The mean age of the patients at the time of surgery was 8.4 years, and the median follow-up period was 7.4 years. Two (5.1%) patients were no longer using their ACE channels, but 15 (38.5%) patients were still using their channels almost daily. Twenty-eight (71.8%) patients complained that performing enema was time-consuming, and seven (17.9%) patients reported pain when performing ACE and fecal incontinence. Most patients were satisfied with their defecation status (23, 59%), 15 (38.5%) were neutral, and one (2.6%) was dissatisfied.

      Conclusions

      Figure
      Graphical AbstractUsage pattern of the Mitrofanoff and anterograde continent enema channels and patients' satisfaction levels.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Woodside J.R.
        Continent vesicostomy.
        Obstet Gynecol. 1980; 55: 767-768
        • Malone P.S.
        • Ransley P.G.
        • Kiely E.M.
        Preliminary report: the antegrade continence enema.
        Lancet. 1990; 336: 1217-1218
        • Atchley T.J.
        • Dangle P.P.
        • Hopson B.D.
        • Graham A.
        • Arynchyna A.A.
        • Rocque B.G.
        • et al.
        Age and factors associated with self-clean intermittent catheterization in patients with spina bifida.
        J Pediatr Rehabil Med. 2018; 11: 283-291
        • Kelly M.S.
        Malone antegrade continence enemas vs. Cecostomy vs. Transanal irrigation-what is new and how do we counsel our patients?.
        Curr Urol Rep. 2019; 20: 41
        • Welk B.K.
        • Afshar K.
        • Rapoport D.
        • MacNeily A.E.
        Complications of the catheterizable channel following continent urinary diversion: their nature and timing.
        J Urol. 2008; 180: 1856-1860
        • Faure A.
        • Cooksey R.
        • Bouty A.
        • Woodward A.
        • Hutson J.
        • O'Brien M.
        • et al.
        Bladder continent catheterizable conduit (the Mitrofanoff procedure): long-term issues that should not be underestimated.
        J Pediatr Surg. 2017; 52: 469-472
        • Leslie B.
        • Lorenzo A.J.
        • Moore K.
        • Farhat W.A.
        • Bagli D.J.
        • Pippi Salle J.L.
        Long-term followup and time to event outcome analysis of continent catheterizable channels.
        J Urol. 2011; 185: 2298-2302
        • Meyer K.F.
        • Macedo M.
        • Filho H.S.
        • Pinto T.R.
        • Galvao L.T.
        • Meneses Q.C.
        The Malone Antegrade Continence Enema (MACE) principle in children: is it important if the conduit is implanted in the left or the right colon?.
        Int Braz J Urol. 2008; 34 (discussion 13): 206-212
        • Kim H.Y.
        • Jung S.E.
        • Lee S.C.
        • Park K.W.
        • Kim W.K.
        Is the outcome of the left colon antegrade continence enema better than that of the right colon antegrade continence enema?.
        J Pediatr Surg. 2009; 44: 783-787
        • Calado A.A.
        • Macedo Jr., A.
        • Barroso Jr., U.
        • Netto J.M.
        • Liguori R.
        • Hachul M.
        • et al.
        The Macedo-Malone antegrade continence enema procedure: early experience.
        J Urol. 2005; 173: 1340-1344
        • Basavaraj D.R.
        • Harrison S.C.
        The Mitrofanoff procedure in the management of intractable incontinence: a critical appraisal.
        Curr Opin Urol. 2006; 16: 244-247
        • Barqawi A.
        • De Valdenebro M.
        • Furness P.D.
        • Koyle M.A.
        Lessons learned from stomal complications in children with cutaneous catheterizable continent stomas.
        BJU Int. 2004; 94: 1344-1347
        • Reddy P.P.
        • Strine A.C.
        • Reddy T.
        • Noh P.H.
        • DeFoor Jr., W.R.
        • Minevich E.
        • et al.
        Triamcinolone injection for treatment of Mitrofanoff stomal stenosis: optimizing results and reducing cost of care.
        J Pediatr Urol. 2017; 13: 375 e1-e5
        • Thomas J.C.
        • Dietrich M.S.
        • Trusler L.
        • DeMarco R.T.
        • Pope 4th, J.C.
        • Brock 3rd, J.W.
        • et al.
        Continent catheterizable channels and the timing of their complications.
        J Urol. 2006; 176 (discussion 20): 1816-1820
        • Poncet D.
        • Boillot B.
        • Thuillier C.
        • Descotes J.L.
        • Rambeaud J.J.
        • Lanchon C.
        • et al.
        Long-term follow-up of continent cystostomy with the Mitrofanoff procedure: 5 years later.
        Prog Urol. 2019; 29: 147-155
        • Jacobson D.L.
        • Thomas J.C.
        • Pope J.
        • Tanaka S.T.
        • Clayton D.B.
        • Brock J.W.
        • et al.
        Update on continent catheterizable channels and the timing of their complications.
        J Urol. 2017; 197: 871-875
        • Thomas J.C.
        • Dietrich M.S.
        • Trusler L.
        • DeMarco R.T.
        • Pope J.C.
        • Brock J.W.
        • et al.
        Continent catheterizable channels and the timing of their complications.
        J Urol. 2006; 176: 1816-1820
        • Siddiqui A.A.
        • Fishman S.J.
        • Bauer S.B.
        • Nurko S.
        Long-term follow-up of patients after antegrade continence enema procedure.
        J Pediatr Gastroenterol Nutr. 2011; 52: 574-580
        • Li C.
        • Shanahan S.
        • Livingston M.H.
        • Walton J.M.
        Malone appendicostomy versus cecostomy tube insertion for children with intractable constipation: a systematic review and meta-analysis.
        J Pediatr Surg. 2018; 53: 885-891
        • Chang H.K.
        • Chang E.Y.
        • Han S.J.
        • Choi S.H.
        • Oh J.T.
        Long-term outcome of left- vs right-sided antegrade continence enema.
        J Pediatr Surg. 2012; 47: 1880-1885
        • Yerkes E.B.
        • Cain M.P.
        • King S.
        • Brei T.
        • Kaefer M.
        • Casale A.J.
        • et al.
        The Malone antegrade continence enema procedure: quality of life and family perspective.
        J Urol. 2003; 169: 320-323
        • Tiryaki S.
        • Ergun O.
        • Celik A.
        • Ulman I.
        • Avanoglu A.
        Success of Malone's antegrade continence enema (MACE) from the patients' perspective.
        Eur J Pediatr Surg. 2010; 20: 405-407
        • Anselmo C.B.
        • do Amaral R.D.
        • Oliveira D.E.
        • da Cruz M.L.
        • Liguori R.
        • Garrone G.
        • et al.
        Left-colon antegrade enema (LACE): long-term experience with the Macedo-Malone approach.
        Neurourol Urodyn. 2017; 36: 111-115
        • Pusic A.L.
        • Klassen A.F.
        • Scott A.M.
        • Klok J.A.
        • Cordeiro P.G.
        • Cano S.J.
        Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q.
        Plast Reconstr Surg. 2009; 124: 345-353
        • Graziani F.
        • Tsakos G.
        Patient-based outcomes and quality of life.
        Periodontol 2000. 2020; 83: 277-294
        • Cano S.J.
        • Browne J.P.
        • Lamping D.L.
        Patient-based measures of outcome in plastic surgery: current approaches and future directions.
        Br J Plast Surg. 2004; 57: 1-11