Continent Appendicovesicostomy in the Management of Valve Bladder Syndrome

Abstract

Purpose Clean intermittent catheterization (CIC) is a cornerstone in the management of VBS. Sometimes, there is difficulty or pain during performing CIC per urethra which might affect patient compliance. Using appendicovesicostomy might allow better patient compliance and have a positive impact in the management of VBS. Material and Methods Appendicovesicostomy was performed in 10 boys with VBS to allow better implementation of CIC (group I). Other 10 boys with VBS performing CIC per urethra were used as a control group (group II). Both groups were followed regarding complications of catheterization (pain, difficulty, and false passage), rate of UTI, compliance and effect on upper tract dilatation. Stomal complications in addition to continence status were recorded in group I. Results Age range in both groups was 3-9 years and the follow up period is 2 years. No complications of catheterization encountered in group I. Pain was present in 6, false passage in 2 and difficulty in 3 boys in group II. As regards UTI, documented upper tract infection was present in one case in group I and in 4 cases in group II. Lower tract infection was present in 2 cases in group I and in 7 cases in group II. Two cases in group II had recurrent epididymitis. Compliance to CIC was 100% in group I while in group II was 70 %. At the last follow up, there was improvement in upper tract dilatation in 4 cases in group I compared to its status before performing the appendicovesicostomy. Only one case in group I had stomal stenosis that needed surgical revision. All stomas were continent in between the period of CIC. Conclusions Continent appendicovesicostomy is a valid procedure in the management of VBS when compliance in CIC is equivocal. It is a safe and easy procedure with long term success that obviates problems of urethral catheterization.