Continent Catheterizable Subcutaneous Channel

For many people with urinary evacuation disorders in non-neurogenic and neurogenic conditions, the bladder capacity is often normal or increased and the major obstacle for improving the impact of their disorder is obtaining access to the bladder. In these complex cases, we have opted to perform a minimally invasive procedure, which we describe as a continent subcutaneous catheterizable diversion (Figure 10-2.4). This novel procedure uses a subcutaneous catheterizable umbilical channel that is attached to the bladder dome. The continence mechanism of the subcutaneous channel is provided by circumferential compression of the rectus muscle after we have crossed the medial fibers of its lower abdominal portion overlying the bladder dome. The channel is constructed of an in situ or free skin graft. In this way, we create a percutaneous subcutaneous tunnel that passes through augmented com-

Figure 10-2.4. Formation of a continent catheterizable subcutaneous channel using a free dermal graft from the umbilicus to the bladder dome. Compression obtained from crossing the fibers of the rectus muscle serves to form the continence mechanism.

pression of the rectus muscle and is attached to the bladder dome for continent bladder access using CIC. This procedure is technically comparable to placement of a suprapu-bic tube and is performed in a same-day ambulatory surgical setting. Two weeks after the minimally invasive procedure, CIC is performed through the subcutaneous channel.

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