A.M. Vastyan A.B. Pinter A. Farkas Cutaneous vesicostomy revisited—the second 15 years Eur J Pediatr Surg 15 2005 (June) 170 174

Abstract

The aim of this paper is to review the authors' experience with cutaneous vesicostomy (CV) over the last 15 years, including indications, results, and complications of CV. The records of 31 patients treated by CV between 1987 and 2002 were reviewed (20 boys, 11 girls). The 2 main primary pathologies were neuropathic bladder (19 patients) and posterior urethral valves (7 patients). All patients underwent a Blocksom-type operation at a mean age of 23 months (range, 14 days to 9 years). Pre- and postoperative conventional uromanometry was performed in 18 patients (58%) and bladder function assessed. In 23 patients (74%), CV provided a successful diversion with improvement of the upper urinary tract and/or stabilization of renal function. In 5 patients (16%) with posterior urethral valves, the improvement was temporary only. In 3 patients (10%), CV did not result in improvement. Twenty-four patients underwent CV closure after a mean duration of 23 months (1 month to 7 years) of diversion. In 2 patients with myelomeningocele and severe somatomental retardation, CV was not closed. Urodynamic studies in 5 patients with posterior urethral valves showed impaired compliance and high intravesical pressure after a successful valve ablation and closure of CV. In the neuropathic bladder group, bladder function improved after closure of CV and commencement of anticholinergic medication and clean intermittent catheterization. Augmentation rate in the neuropathic bladder group was 22%. Complications after CV included 7 stenosis (22%), 2 prolapse (6%), and 2 cellulitis (6%). Revision rate was 16%. It was concluded that CV had a less favorable outcome in young infants with posterior urethral valves than in high-pressure neuropathic bladder with upper tract dilatation and severe urinary tract infection, where CV provided decompression and prevented deterioration of renal function. Cutaneous vesicostomy has stood the test of time and remains a valuable tool in selected pediatric urological patients.