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S22-4
(PP)
DOES ENDOSCOPY OF DIFFICULT TO CATHETERIZE CHANNELS SUBSEQUENTLY
LEAD TO FORMAL OPEN REVISION?
Jessica CASEY, Mimi ZHANG, Katherine HUBERT, Konrad SZYMANSKI, Benjamin JUDGE, Benjamin WHITTAM, Martin
KAEFER, Rosalia MISSERI, Richard RINK and Mark CAIN
Riley Hospital for Children, Division of Pediatric Urology, Indianapolis, USA
PURPOSE
Patients with continent catheterizable channels (CCCs) may develop difficulty catheterizing postoperatively. To address
this we typically perform endoscopic evaluation and, if necessary, leave a catheter in the CCC for several weeks. The
purpose of this study was to evaluate whether endoscopic management is predictive of the need for formal open
revision of the CCC.
MATERIAL AND METHODS
We performed an IRB-approved retrospective review of pediatric (<21 years old) patients undergoing CCC construction
at our institution between 2000-2015 to identify patients who underwent endoscopy for difficulty catheterizing. Fisher’s
exact test was used for categorical data and Mann-Whitney U-test for continuous variables.
RESULTS
14.5% (63/434) underwent at least one endoscopy for reported difficulty catheterizing their CCC, with 77.8% requiring
additional intervention during endoscopy (catheter placement, dilation, etc.). Of these, almost half (29/63, 46.0%) were
managed successfully with endoscopy without formal revision; six (20.7%) of which underwent more than one
endoscopy. These 29 patients continued to catheterize well at a median follow-up of 3.0 years (interquartile range 1.9-
5.3). 82.3% of those subsequently revised vs. 72.4% of those not revised needed intervention during endoscopy
(p=0.38). Patients who were revised had a median of 1.6 years between CCC creation and first endoscopy vs. 1.7 years
in those who were not revised (p=0.53).
CONCLUSIONS
The need for endoscopic management of CCCs is not predictive of eventual formal revision, as almost half of our
patients have avoided for formal revision. We recommend performing at least one endoscopic intervention prior to
proceeding with formal open revision; the tolerable number of endoscopic interventions prior to converting to formal
revision should be determined by the individual surgeon.