Pediatric Continent Urinary Stoma Placement Anesthesia - AnethAssist

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Pediatric Continent Catheterizable Urinary Stoma — What it is

Creation of a catheterizable abdominal channel using appendix or bowel, including Mitrofanoff appendicovesicostomy or Monti tube.

Pediatric Continent Catheterizable Urinary Stoma — Common indications

Lifetime catheterization, neurogenic bladder, urinary retention or incontinence, motor impairment, spina bifida, spinal cord injury, or cerebral palsy.

Pediatric Continent Catheterizable Urinary Stoma — Position

Supine.

Pediatric Continent Catheterizable Urinary Stoma — Surgical access

Lower midline exposure; appendix or bowel forms a tunneled channel to an umbilical stoma with an indwelling patency catheter.

Pediatric Continent Catheterizable Urinary Stoma — Typical duration

Approximately 4.5 h with augmentation or 1.5 h without augmentation.

Pediatric Continent Catheterizable Urinary Stoma — Expected blood loss

Approximately 100 mL when performed with bladder augmentation.

Pediatric Continent Catheterizable Urinary Stoma — Pain and stimulation

Major abdominal stimulation with bowel and bladder manipulation when combined with augmentation.

Pediatric Continent Catheterizable Urinary Stoma — Anesthetic options

GETA with active warming, broad-spectrum antibiotics, fluid and electrolyte management, and epidural, truncal, or local analgesia.

Pediatric Continent Catheterizable Urinary Stoma — Airway

Standard pediatric ETT; associated neurologic disease, prior surgery, aspiration risk, and prolonged abdominal exposure may influence airway planning.

Pediatric Continent Catheterizable Urinary Stoma — IV and blood preparation

Use one or two IVs according to complexity; add arterial pressure monitoring and blood readiness with augmentation or renal disease.

Pediatric Continent Catheterizable Urinary Stoma — Monitoring

Standard monitors, temperature, urine output, glucose, and electrolytes; add arterial pressure for major augmentation or renal dysfunction.

Pediatric Continent Catheterizable Urinary Stoma — Ventilation and physiology

Controlled ventilation supports abdominal exposure; bowel distention and prolonged intraperitoneal work can impair mechanics and venous return.

Pediatric Continent Catheterizable Urinary Stoma — Regional options

An indwelling epidural or caudal technique may supplement GA; IV opioids or PCA are alternatives when neuraxial analgesia is unsuitable.

Pediatric Continent Catheterizable Urinary Stoma — Positioning risks

Pad pressure points and protect the eyes; maintain warming and secure all bladder, suprapubic, and stoma catheters during prolonged supine surgery.

Pediatric Continent Catheterizable Urinary Stoma — Major intraoperative risks

Bowel injury, contamination, hemorrhage, hypothermia, electrolyte disturbance, catheter obstruction, and latex reaction.

Pediatric Continent Catheterizable Urinary Stoma — Major postoperative risks

Stomal stenosis 30-40%; combined augmentation adds electrolyte abnormalities, bladder calculi, augmented-bladder rupture, bowel obstruction, and bladder-cancer risk.

Pediatric Continent Catheterizable Urinary Stoma — Postoperative destination

PACU to ward with catheters maintaining bladder, suprapubic, and stoma drainage as planned.

Pediatric Continent Catheterizable Urinary Stoma — Critical communication

Confirm appendix versus Monti channel, augmentation, bladder-neck procedure, urine culture, antibiotics, and every catheter or drainage pathway.

Pediatric Continent Catheterizable Urinary Stoma — Fast pearl

When augmentation is combined, independently verify urethral, suprapubic, and catheterizable-channel drainage before leaving the operating room.