THE GASTRIC AUGMENT SINGLE PEDICLE TUBE CATHETERIZABLE STOMA - A USEFUL ADJUNCT TO RECONSTRUCTION OF THE URINARY-TRACT

Since 1990 we have used stomach for bladder augmentation and continent urinary diversions in 73 patients, of whom 15 received a gastric tube catheterizable stoma and are the subject of this report. The gastric tube receives its blood supply from the same vascular pedicle as the g astric patch and, therefore, it can be moved anywhere along with the p atch. The tube is then reimplanted in the reservoir or bladder followi ng the Mitrofanoff principle and brought to the skin as a catheterizab le stoma. Patient age ranged from 12 to 60 years. Three patients under went augmentation cystoplasty and 12 received a composite gastrointest inal continent reservoir (in 10 a prior bowel conduit was detubularize d and used as part of the reservoir). The appendix was either previous ly removed (10 patients) or not suitable as a catheterizable limb (4). All patients are continent. Catheters used to empty the reservoir var ied from 12F to 18F. Complications included an early traumatic perfora tion of the tube in 1 patient, distal stenosis in 1 and mucosal redund ancy in 1. Of these patients 2 required revision. TWO patients had mil d peristomal skin irritation without ulceration. Anatomical and techni cal aspects of this procedure are presented. In summary, we believe th e gastric augment single pedicle tube to be a useful tool for the reco nstructive urologist, which in select cases may obviate the need for a dditional bowel anastomosis to create a tapered intestinal catheteriza ble limb.