CONTINENT GASTRIC TUBE - NEW TECHNIQUES AND LONG-TERM FOLLOW-UP

Purpose: The successful use of stomach for bladder augmentation and su bstitution is well documented. Gastric tissue has been used more recen tly to create continent catheterizable tubes. We describe 2 new techni ques of gastric tube construction, and report our long-term followup o f catheterizable gastric tubes in children and adults undergoing compl ex urinary tract reconstruction. Materials and Methods: A retrospectiv e chart review of 6 male and 4 female patients 5 to 43 years old was d one. Primary diagnoses included bladder exstrophy, cloacal exstrophy, rhabdomyosarcoma and neurogenic bladder. Five patients underwent gastr ocystoplasty with simultaneous creation of a continent gastric tube fr om the anterior gastric flap. In 2 patients who had undergone previous gastrocystoplasty a continent gastric tube was created from an anteri or flap raised from the existing gastric bladder. Isolated gastric tub es were constructed in 3 patients. Results: Followup ranged from 2 to 9 years (median 3.5). All patients demonstrated easy reliable catheter ization. One patient required revision of the proximal end of the tube for incontinence. At followup all tubes were continent. Complications occurred only in flush or protuberant stomas, and resolved after stom al revision with recessed skin naps. Conclusions: Several techniques c an be used to create a continent gastric tube. Long-term followup reve als reliable catheterization and good continence rates. Recession of t he gastric tube stoma with a skin flap prevents peristomal complicatio ns.