Abstract General Information

Title

MACEDO ILEAL CATHETERIZABLE RESERVOIR ADDING THE SCISSORS MANEUVER (YACHIA) TO IMPROVE URINARY CHANNEL CONTINENCE: LONG TERM FOLLOW-UP.

Introduction and objective

The Macedo ileal catheterizable channel (BJU, 2000) consists of an enterocystoplasty with a catheterizable channel precluding the need of the appendix for the outlet. After 25 years of experience with this technique, we decided to review our experience in a select subgroup of cases performed and followed by the author in a non-teaching hospital facility after the latest modifications of the procedure.

Method

Since 2008, we have refined our technique as follows: small transverse incision with semicircular flap for stoma creation in the midline and the scissors maneuver (Yachia). This maneuver consists of crossing two 2 cm rectal muscle flaps in the midline to create a neosphincter over the catheterizable channel. Follow-up was defined as the interval between the date of surgery and last visit to the clinic. We defined stoma continence if the interval between catheterization was 4hs. Early and late complications were reported as well as the reintervention rate.

Results

We have treated 52 patients. Indications were spinal dysraphism (77.1%), mainly myelomeningocele (67.9%) and others (PUV, exstrophy, anorectal anomalies). Urodynamic evaluation showed bladder pressure of high risk for upper urinary tract involvement (66%), urinary incontinence (24.5%), bladder exstrophy (1.9%), detrusor hypocontractility (1.9%), conversion of incontinent urinary diversion (3.8%). Mean age at surgery was 88 months (7.3 years), 20 patients had additional surgeries in addition to Macedo ileal catheterizable channel: Macedo-Malone Left Antegrade Continent Enema procedure in 17 patients and bladder neck surgery to improve continence for 4 patients. Stoma continence was 90.6% after first surgery (48 patients) and stoma revision was done in 7 cases (4 skin flap to channel and 3 leakage revisions: 2 treated with an endoscopic procedure and 1 case with open revision.

Conclusion

We confirmed in a long term follow-up based on face-to-face visits of 7.3 years that the Macedo procedure associated with the scissors maneuver is associated with 90.6% continence of the stoma, which is superior to most procedures.