Modified technique of Triamcinolone injection for the treatment of Mitrofanoff stomal stenosis: Optimizing results and reducing cost of care
Andrew C. Strine, MD, Trisha Reddy, BS, Brian A. VanderBrink, MD, Paul H. Noh, MD, William R. DeFoor, Jr., MD, MPH, Eugene Minevich, MD, Curtis A. Sheldon, MD, Pramod P. Reddy, MD.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Continent catheterizable channels (CCCs) using the Mitrofanoff principle are often created during continent reconstruction but may develop stomal stenosis in up to 30% of patients. We describe our experience with a modified technique of triamcinolone injection for the treatment of stomal stenosis, thereby avoiding the need for a more invasive and costly stomal revision.
We performed a retrospective review of patients who underwent a modified technique of triamcinolone injection (40 mg/mL) for the treatment of stomal stenosis at our institution. Demographic and clinical data were assessed. A successful outcome was defined as a return to ease with catheterization. We also assessed the cost of care with various techniques for the treatment of stomal stenosis by representing the cost as a percentage of charges for a re-operative Monti ileovesicosotmy.
A total of 22 injections were performed in 18 CCCs of 17 patients. Demographic and clinical data are provided in Table 1. Twenty patients (91%) underwent the injection under general anesthesia, while 2 patients (9%) with poor sensation due to myelomeningocele underwent an office-based procedure. Thirteen CCCs (72%) were successfully treated with a single injection. Three patients (10%) required a total of 5 repeat injection at a median of 5.1 months between injections (range, 3.2-18.4), while only 1 patient required a stomal revision at 34.9 months after the initial injection. There were no predictors of failure after the initial or any injection on univariate analysis. The cost of care was 11.3% for a stomal revision, 5.8% for Triamcinolone injection in the operating room, and 0.3% as an office-based procedure.
Our modified technique of triamcinolone injection was a durable option for the treatment of stomal stenosis in any cutaneous stoma with a success rate of 72% after a single injection.
|Median age at surgery in years||10.5|
% cloaca, cloacal exstrophy, and variants
% sacral agenesis
% tethered cord
% Prune Belly syndrome, anorectal malformation
% Monti ileovesicostomy
% spiral Monti ileovesicostomy
% Malone appendicocecostomy
% Monti ileocecostomy
% neo-Malone with cecal flap
|% split-appendix technique||56|
|% right lower quadrant stoma|
% left lower quadrant stoma
% umbilical stoma
|% prior stomal revision|
% prior dilation
% subfascial revision
|% general anesthesia for injection|
% no anesthesia for injection
|Median time from creation of CCC to triamcinolone injection in months||26.1|
|Median follow-up in months||10.9|
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