Endoscopic insertion of Cystostomy Button for Bladder Drainage

Abstract

PURPOSE Our aim is to present our experience with insertion of buttons for bladder drainage and cycling in children. MATERIAL AND METHODS This is an ongoing prospective study for over 5 years from 2002 looking at our experience with endoscopic insertion of cystostomy buttons in children. We initially performed this procedure by an open surgical approach but have now modified our practice to an percutaneous endoscopic technique. This new technique involves insertion of a cystoscope into the bladder which is then punctured with a needle under vision. A guide wire is introduced, needle removedand replaced with a peel away sheath. The outer sheath is then peeled, obturator removed and the appropriate size button device is inserted. The balloon is then inflated with 5 mls of water to allow a snug fit. The button can then be used to drain the bladder intermittently or cycle it with the extension set. RESULTS Twenty-five children (11 girls:14 boys) with a mean age of 8.6 years underwent insertion of a cystostomy button (15 open: 10 endoscopic). Mean follow up was 16 months (2–44). Indications include neuropathic bladder, prune belly syndrome, previous major bladder neck surgery, those unsuitable for mitrofanoff and bladder cycling prior to reconstruction. Complications include 1 wound infection (treated with antibiotics); four children had leakage of urine (all open approach) successfully treated with a change in button size. Twenty buttons remain in situ. Change of button is a straightforward procedure and can be performed in an outpatient setting. The endoscopic insertion allows a snug fit (no leakage with this technique) and is performed in less than 10 minutes. CONCLUSIONS Button cystostomy is a safe and effective form of bladder drainage in children. It is a good alternative to standard suprapubic drainage and it gives children a less restricted quality of life. Endoscopic insertion allows insertion of buttons under vision with good snug fit and no leakage.