CODE: 17 - Own method of continent urinary stoma construction
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Lidia Skobejko-Włodarska

Klinika Urologii Dziecięcej - Instytut CZD w Warszawie

summary

The aim of the study. Evaluation of usefulness of own method of continent urinary stoma construction and its use in patients with troubles in learning CIC via urethra.

Material and method. In 80 patients with neuropathic bladder due to congenital malformation of Central Nervous System (79 patients) and spinal trauma (1 patient) construction of continent urinary stoma was performed. Indications to this operation included: troubles or inability in learning catheterization (CIC) via urethra because of severe paraplegia, bone deformities, iatrogenic damage of the urethra with its stenosis or necessity of closing the bladder neck with construction of continent reservoir. To construct the continent stoma different materials as appendix, 4 cm length fragment of ilium or sigmoid and ureter were used. In 24 patients out of 80 qualified to continent urinary stoma construction own method of continent stoma construction was applied. Among them in 19 patients appendix was used to construct continent appendicocaecostomy and in other 5 patients it was not possible to approach the appendix due to adhesions or high position of caecum. The idea is supported by using 4-4,5 cm length of ilium or sigmoid segment. The bowel fragment is detubularized, placed transversally and formed in tube along its diagonal round about catheter 12-14 F. This maneuver allows to construct tunnel of continent stoma 11-12 cm long. It has the biggest advantage in patients with obesity and bone deformities and long distance between bladder and place of stoma localization.

Results. Patients' follow-up ranged from 1 year to above 4 years. The complications were observed in 3 patients in whom own method of continent urinary stoma construction was applied and included: 1 stomal stenosis within the skin, 1 stomal incontinence and false route in 1 patient.

Conclusion. The described method is one of the simple way of continent urinary stoma construction especially in situation when the appendix can not to use to stoma creation. The method is helpful in obese patients or in patients with bone deformities because it enables to create longer tunnel of continent stoma in the presence of long distance between bladder and place of stoma.