Use and disuse of catheterizable channels as the primary method of emptying the neuropathic bladder: a single institutional cohort study.

Abstract

Purpose: We aimed to assess long-term use of continent catheterizable urinary channels (CCCs) and explore potential risk factors for disuse.

Materials and methods: People undergoing appendicovesicostomy and Monti procedures at our institution were retrospectively reviewed (1991-2023). The main outcome was CCC disuse (not intermittently catheterizing channels as the primary method of bladder emptying). Cox regression was used.

Results: 561 people (46% male, 57% shunted, 72% spina bifida) met inclusion criteria (244 appendicovesicostomy, 317 Monti; 69% right lower quadrant [RLQ]). Channels were created at a median age of 8 years (median follow up: 11 years, 78% self-catheterized). Overall, 76 people disused their channels. Most common reasons for disuse were non-mechanical (64%). After disuse, 46% underwent incontinent diversion.After correcting for differential follow-up, 89% of people still used their channels at 10 and 81% at 20 years, respectively. When analyzing all disused channels in patients reaching adulthood on multivariable analysis, channels catheterized by others had 3.78 times the risk for disuse compared to self-catheterized channels (p<0.001); RLQ channels were 1.06 times more likely to be disused than umbilical channels (p=0.02).For channels disused for non-mechanical reasons, catheterization by others, not attending transition clinic, and RLQ stoma were independently associated with disuse (p≤0.04). No variables were associated with disuse for mechanical reasons (p≥0.22).

Conclusions: Most people with CCCs use them on long-term follow-up. 1% stopped using them annually. People who never self-catheterized, never attended transition clinic or had RLQ stomas were at higher risk of channel disuse, particularly due to non-mechanical reasons.