We’ve written up what I call a recipe for success. The use of the constructed conduits begins in the operating room, where we check several things. We check for continence once we place it in the bladder; we fill the bladder and check for continence again. Every step of the way we check for ease of catheterization. If catheterization becomes more difficult, we go back a step and re-do it, so catheterization is done with ease every step of the way.

After recovery from the operation, two weeks later, we do a bladder X-ray. If that looks okay, no leaks, the surgeon does the first catheterization while the patient is awake, with sensation, understanding what we are trying to do, what eventually the parent or caretaker will do, and hopefully even the child will do at some point. That’s another step in the process along the way of making sure everything goes well, and I like to be there for the first several attempts and watch very carefully the progression of how it’s done, the timing of when it’s done, making sure everything proceeds in a stepwise fashion. If there’s a little trouble, then we take a step back and ask why, all the time discussing it with the family and the patient, so that they understand what we’re trying to do and why.

Joseph Borer, MD, Department of Urology