Continent catheterizable channels (CCCs) are a viable option for patients with neurogenic bladder who cannot perform intermittent self-catheterization (ISC) due to severe urethral pathology or when accessing the urethra is nearly impossible (1). These channels provide an alternative drainage route via an abdominal stoma, which is often located at the umbilicus for both cosmetic reasons and ease of catheterization. CCCs are typically constructed using the appendix (Mitrofanoff procedure) (2),  a re-tubularized short or double intestinal segment (Yang-Monti or Casale methods)(3),  or similar techniques employing the efferent limb of a Kock or Indiana pouch. In cases requiring more extensive surgical intervention, CCCs may be combined with augmentation cystoplasty and bladder neck closure. Despite their effectiveness, data on the use of CCCs in spinal cord injury (SCI) patients are limited.

One of the potential complications of CCCs is the formation of fistulas, which are abnormal connections that can develop between the bladder and other organs or tissues. This can result from surgical techniques, tissue ischemia, or infection. Fistula formation can lead to leakage, infections, and significant patient discomfort, requiring further surgical intervention to repair. 
We present a case of fistulous complication of CCC that resulted in urinary leakage through the diversion requiring revision of the CCC with successful outcome.

A 25-year-old lady with history of myelomeningocele and neurogenic bladder had undergone ileo-cystoplasty and CCC in our center 6 years prior to presentation. The CCC was done using a tailored ileal segment implanted in an S-shaped pouch through a serous lined extramural tunnel.
The patient used to have good continence and to catheterize through the umbilical stoma with average output around 500 ml/ cath. For the 6 months prior to presentation, the patient noticed recurrent urinary leakage through the stoma and a decrease in the output to about 250 cc.
Cystoscopy showed a fistulous tract opening between the mid part of the channel and the main pouch. The opening seemed to be a result of a false passage during catheterization. The patient was counseled for exploration of the augmented bladder and possible revision of the CCC.

Under general anesthesia, Foley’s catheter size 16 Fr inserted through the CCC. Through a lower mid line incision around the stoma tract, dissection done revealing the augmented bladder. The augmented bladder was opened showing a fistulous tract extending between the middle of the CCC into the bladder cavity. The fistula was repaired in two layers. The CCC was examined to show easy passage of the catheter and intact tract lining. Indwelling catheter was kept on the CCC for two weeks. On follow up the patient had excellent continence outcome with no leakage through the CCC. Flexible cystoscopy showed good healing of the fistulous tract.

CCCs offer a practical solution for patients unable to perform ISC, though they carry risks such as fistula formation. Careful follow up of such patients is essential to mitigate complications and achieve favorable outcomes.

Wyndaele JJ, Birch B, Borau A, Burks F, Castro-Diaz D, Chartier-Kastler E, Drake M, Ishizuka O, Minigawa T, Opisso E, Peters K, Padilla-Fernández B, Reus C, Sekido N. Surgical management of the neurogenic bladder after spinal cord injury. World J Urol. 2018 Oct;36(10):1569-1576.
Cendron M, Gearhart JP (1991) The Mitrofanoff principle. Tech nique and application in continent urinary diversion. Urol Clin N Am 18:615–621
Monti PR, de Carvalho JR, Arap S (2000) The Monti procedure: applications and complications. Urology 55:616–621