Island pedicle graft in stomal stenosis: a new technique

Technique of Suprafascial Anastomosis With Reduced Risk of Stenosis of the Efferent Outlet in Continent Catheterizable Urinary Diversion

OBJECTIVE

To describe our technique and long-term experience with a technique of a suprafascial anastomosis for the efferent continent segment in continent cutaneous urinary diversion, which aims to reduce the rate of stomal strictures.

MATERIALS AND METHODS

Between 1998 and 2013, up to 191 patients underwent continent cutaneous urinary diversion with a suprafascial anastomosis technique at our institution. A complete follow-up was achievable in 82 patients. The retrospective analysis included continence rates, stomal complications, and other complications related to the urinary diversion such as anastomotic insufficiencies, fistulas, or hernias.

RESULTS

The study population consisted of 82 patients with 67 (82%) women and 15 (18%) men with a median age of 58 years. The median length of follow-up was 82 months (range 13-203) with a median survival time of 46 (range 13-193) months. At the time of the analysis, 46 patients (57%) were still alive. Five out of 82 patients (6%) presented with a relevant stenosis in umbilical stoma that required surgical revisions. Nine patients (12%) with functional stenosis could be treated conservatively. Continence was achieved in 74 of 82 patients (90%). Only 8 patients reported some degree of incontinence.

CONCLUSION

The technique of a suprafascial stoma is a simple and safe technique that may help prevent the incidence of stomal complications.

Island pedicle graft in the correction of urethral meatal stenosis following hypospadias repair

We present our experience with the use of a vascularized island pedicle graft in the correction of urethral meatal stenosis following hypospadias surgery. In 5 patients treated with this new technique the stenosis was corrected and voiding flow patterns returned to normal.