Introduction: Urinary diversion has long been a necessity for patients requiring complex urologic care, both in adult and pediatric settings. Cutaneous catheterizable channels allow for continent bladder emptying, with maintained quality of life and without the need for ostomy or appliances, or development of renal injury. Here we review the history and development of the catheterizable channel in urology.
Methods: A review of medical publications and the PubMed database was performed to identify historical information about the development of catheterizable channels for urinary diversion.
Results: Advances in catheterizable urinary diversion began in the early 1900’s and evolved through the 20th century. First described by Verhoogen and Makkas, the cecoappendiceal unit was used as a catheterizable channel, albeit with no true continence mechanism described. Gilchrist would later create a catheterizable continent reservoir from cecum and right colon, using the terminal ileum as the channel and the ileocecal valve as the continence mechanism. With Bricker describing the ileal conduit for urinary diversion, progress in development of the catheterizable channel slowed for two decades. When Lapides described the safe utilization of clean intermittent catheterization for neurogenic bladder patients, the desire for further development was rekindled. Mitrofanoff would develop and describe the use of the appendicovesicostomy. Mitrofanoff’s work would be expounded upon by Ducket and Snyder who offerred ureteral modifications and variations on the so-called Mitrofanoff priniciples. Other alternatives to the appendiceal channel have been developed, including ureteral channels, tapered ileum, fallopian tube, preputial tube, and vas deferens channels, all of which have of problematic anatomical or vascular pitfalls. However, the Yang-Monti channel has proven to be a reasonable alternative to the appendiceal channel, with higher rates of revision than appendiceal channels, but drastically more durable and successful than other alternatives.
Conclusions: The continent catheterizable channel is one of the great advances in urologic surgical technique. It’s development has been lead by leading urologists, through multiple schools of thought and varied efforts leading to our current understanding. As surgical and technical advancement develops, there remains room for further progress.
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