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BACKGROUND:
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.
METHODS:
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.
RESULTS:
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.
CONCLUSIONS:
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.

Table 1. Demographic and clinical data

Median age at surgery in years	10.5
% male % female	41 59
% myelomeningocele % cloaca, cloacal exstrophy, and variants % sacral agenesis % tethered cord % Prune Belly syndrome, anorectal malformation	53 24 12 6 6
% appendicovesicostomy % Monti ileovesicostomy % spiral Monti ileovesicostomy % Malone appendicocecostomy % Monti ileocecostomy % neo-Malone with cecal flap	44 22 6 17 6 6
% split-appendix technique	56
% right lower quadrant stoma % left lower quadrant stoma % umbilical stoma	78 11 11
% prior stomal revision % prior dilation % subfascial revision	22 6 6
% general anesthesia for injection % no anesthesia for injection	91 9
Median time from creation of CCC to triamcinolone injection in months	26.1
Median follow-up in months	10.9