Outcomes after continent catheterizable channel creation in a pediatric population: A comparison between open and robotic approach
Sahar Eftekharzadeh, MD, MPH1, Sameer Mittal, MD, MSc1, Alice Xiang, MD, MSc2, Iqra Nadeem, BA1, Aznive Aghababian, BS1, John Weaver, MD1, Katherine Fischer, MD1, Karl Godlewski, MD1, Christopher J. Long, MD1, Dana A. Weiss, MD1, Stephen A. Zderic, MD, PhD1, Douglas A. Canning, MD1, Aseem R. Shukla, MD1, Arun K. Srinivasan, MD, MRCS1.
1The Children's Hospital of Philadelphia, Philadelphia, PA, USA, 2Einstein Healthcare Network, Philadelphia, PA, USA.
BACKGROUND: Continent catheterizable channels (CCC) permit an alternative route for clean intermittent catheterization (CIC) that may decrease discomfort and complications associated with CIC via urethra. CIC may be required in pediatric patients for a variety of indications and in recent years there has been an interest in creating catheterizable channels using a minimally invasive approach. Our aim was to compare the outcomes of open and robot-assisted laparoscopic CCC creation at our institution over an 8-year period.
METHODS: We queried a retrospective database of patients undergoing major urinary tract reconstructive surgery to identify all patients <18 years who underwent initial CCC creation at our institution between 2012 and 2020. Patients who underwent concomitant bladder augmentation were excluded from the study. We comprehensively reviewed patients' records to evaluate perioperative outcomes, incidence, and severity of short-term complications, as well as long-term outcomes including urinary continence, need for revisions, and further surgeries.
RESULTS: Of the 75 CCC creations (73 patients) identified, 43 (57%) met inclusion criteria. The median age at surgery of the 43 patients (20 females, 23 males) was 9.8 (IQR: 7.0, 13.8) years. Type of channels included: 36 (88%) appendicovesicostomies, 3 (7%) Monti ileovesicostomies, and 4 (9%) channels created using bladder flap or ureter. There were 22 (51%) patients who underwent robotic approach, of whom 1 (4.5%) required conversion to open approach. Complications within 30 days of surgery occurred in 27 (63%) patients, with 81.5% of complications being Clavien Grade I or II. Complications within 31 to 90 days of surgery occurred in 20 (47%) patients, with 85% of complications being Grade I or II. 15 (35%) had stoma or channel-related complications, for which 13 (30%) required revision. Renal function was stable or improved in 28 (80%) during follow-up. During the median follow-up of 53.3 (IQR: 28.9, 94.0) months, 10 (%) patients underwent procedures for incontinence. There was no significant difference in the long-term outcomes and continence status between the two groups (Table 2). CONCLUSIONS: CCC creations are complex procedures associated with an over 50% complication rate but more than 80% of short-term complications were low-grade and did not require surgical intervention. In long-term follow up patients required stoma or channel revision and interventions for improvement of continence. We found no difference in short- or long-term outcomes between the robotic and open approach. 
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