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The Use of Interventional Radiology In Re-Establishment of Lost Access to Continent Catheterizable Channels

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Gina M. Lockwood, M.D.1, David Moe, M.D.2, Craig Johnson, D.O.2 and Travis Groth, M.D.3, (1)Urology, Medical College of Wisconsin, Milwaukee, WI, (2)Pediatric Interventional Radiology, Children's Hospital of Wisconsin, Milwaukee, WI, (3)Pediatric Urology, Children's Hospital of Wisconsin, Milwaukee, WI

Purpose: To evaluate the efficacy of Interventional Radiology (IR) procedures in regaining lost access to continent catheterizable channels and in prevention of future surgical revision of the channels in pediatric urology patients.

Methods: We performed a retrospective chart review over eight years of children presenting with lost  access to a catheterizable channel for urinary or bowel drainage. Rates of successful re−establishment of access in IR and rates of future surgical revision were calculated.

Results: Twenty patients, ages one to 21 years, underwent attempts to re-establish lost access, some patients on multiple occasions. IR regained access via a minimally invasive technique with pigtail or foley catheter in 24 of 31 attempts (77%). None of these procedures required general anesthesia, and only four (13%) required conscious sedation. Of the 20 patients, eight (40%) never had to undergo eventual surgical revision to allow return to intermittent catheterization after a successful IR procedure. Eight (40%) did eventually require surgery, whether that entailed revision, endoscopy, or suprapubic tube placement, even after successful IR re-establishment of access. All four patients in whom IR access was unsuccessful required surgery. 

Conclusion: Image−guided re-establishment of access for continent catheterizable channels in children is a useful and minimally−invasive treatment option to allow for resumption of self−catheterization and to obviate the need for surgical correction. This data is valuable in directing treatment course and in counseling families about potential clinical outcomes.