Fall 2010 - SSM Cardinal Glennon Children's Medical Center

Silent Service
Reconstruction for Independence
Treon McKinzie, 12, is ready for independence, but first she
must depend on pediatric urologist Casimir Firlit, M.D.
Born with myelomeningocele, lumbar lesion, with hydrocephalus,
Treon has a VP shunt for hydrocephalus, which was
placed at birth. Despite medical management and intermittent
bladder catheterization, at 3 years old she had increased
dilation of both kidneys as well as development of bilateral
severe vesicoureteral reflux with frequent urinary tract infections.
In order to protect her kidneys from damage, a vesicostomy
was completed in which the bladder wall was brought to the
abdominal wall and an opening was created in the lower abdominal
wall below the umbilicus to allow urine to flow out
of the bladder continuously. This has protected the kidneys
well, but required her to wear diapers at all times due to the
continuous, unobstructed flow of urine out of the bladder.
“It’s important for children like Treon that we find solutions
for issues like continence,” Dr. Firlit says. “She has a right to
live like any other child and have that independence. She is
the reason I do what I do.”
Dr. Firlit, Treon and Treon’s mother elected to complete two
stages of reconstructive surgery to maximize the outcome.
During Stage 1, the vesicostomy was closed and a suprapubic
tube was place in the bladder, exiting through the abdominal
wall in her left lower abdomen. The tube is connected to a
drainage bag for approximately four weeks, allowing the bladder
to fully heal.
Stage 1 also included the creation of a tubulzarized Appendico
Cecostomy, often referred to as an ACE. This surgery uses the
appendix to create a continent channel and a small opening in
the right lower abdomen. Through this opening, Treon will be
able to give herself a low volume enema while sitting on the
toilet, emptying her entire colon of stool and allowing her to
be continent of stool between treatments. With teaching and
practice, she will be able to do this procedure independently,
allowing her the opportunity for a self-directed and responsible
quality of life.
After healing of her bladder is confirmed by radiologic
cystogram, the bladder catheter will be plugged for increasing
lengths of time to train her bladder to hold urine for four
hours – this capacity has not been there for nine years. Once
this training is complete in about three to four months, Treon
will return to the operating room for Stage 2 – the Monti procedure
and, if necessary, a bladder neck sling should leakage
of urine from the urethra persist.
After healing from the Monti surgery, Treon will be able to
catheterize her bladder intermittently through a small opening
in the left lower abdomen, with improved continence between
catheterizations.
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sum reris atur Abo. Ut molestiur Genectur
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