In an effort to improve catheterization comfort for sensate patients with continent catheterizable channels (CCC), a novel technique was implemented using submucosal bladder bulking, termed the “Vermont Ski Slope.” This minimally invasive approach aims to alleviate pain often caused by catheter tip contact with the bladder trigone, a common issue leading to less frequent or incomplete emptying and associated complications like infections and hydronephrosis. In this method, four patients experiencing significant pain and urinary complications underwent a new procedure in which 4-6 cc of Hyaluronic Acid & Dextranomer (HA & Dx) was injected at the bladder’s 6 o’clock position just below the entry of the catheterizable channel, creating a mound or “ski slope” to deflect the catheter away from the trigone. Real-time ultrasound and cystoscopic guidance ensured accurate placement, and patients resumed their usual catheterization regimen without requiring indwelling catheters.
Across five procedures performed on four patients, no immediate postoperative complications were noted. Pain during catheterization was fully resolved in all cases, leading to improved bladder function and outcomes. Follow-up, ranging from 3 to 93 months (median 13.5 months), revealed sustained benefits: one patient achieved a period of dryness exceeding three hours, and another patient showed significant improvement in hydronephrosis. The method proved durable, with one patient experiencing no pain for six years before requiring a repeat procedure. These results suggest that the Vermont Ski Slope approach, with its minimal invasiveness and effectiveness, could serve as a viable alternative to open surgical revision for patients with CCCs experiencing catheterization pain. The technique provides a valuable option in managing pain and improving compliance in sensate patients with catheterizable channels.
