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J Urol. 2010 Sep;184(3):1116-21. doi: 10.1016/j.juro.2010.05.019. Epub 2010 Jul 21.

Use of cutaneous flap for continent cystostomy (daoud technique).

Author information

  • 1Pediatric Surgical Unit, CHU Reims, American Memorial Hospital, Reims, France.

Abstract

PURPOSE:

We present the results of a new technique using a pedicled cutaneous flap for continent cystostomy.

MATERIALS AND METHODS:

A total of 15 boys and 8 girls (mean +/- SD age 13.4 +/- 6.4 years) underwent continent cystostomy for neurogenic bladder (20), bladder exstrophy (2) and sequelae of hypospadias (1) between 1999 and 2008. In this procedure a rectangular pedicled flap is surgically elevated from a hairless area on the abdomen. The flap is tubularized and passed through the anterior abdominal wall directly into the bladder. A submucosal detrusor incision is made to expose the bladder mucosa, and the distal part of the flap is anastomosed to the bladder mucosa in a circular manner. The tube is positioned along the incised detrusor, which is closed over. Viability of the flap, self-catheterization management and continence status are then evaluated.

RESULTS:

Mean +/- SD followup was 4.5 +/- 3.1 years. There was 1 case of distal necrosis of the flap, which required a secondary surgery using the Mitrofanoff technique. The 22 remaining flaps were initially viable, although 2 patients were eventually lost to followup and 3 subsequently presented with false-passage incidents requiring a few days of calibration using a balloon catheter. Dryness was achieved immediately in 73% of the cases. After adding a complementary bulking agent the dryness rate reached 77%.

CONCLUSIONS:

We present a novel approach to continent cystostomy that is safe and easy to perform. This technique is a less invasive and more efficient alternative to other commonly used approaches.

2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Comment in

PMID:
20650478
[PubMed - indexed for MEDLINE]
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