Endoscopic Mic-Key® Button Placement for Continent Vesicostomy

Abstract

The use of a gastrostomy button for intermittent emptying of the bladder has been already proposed. The aim of this study was to describe a percutaneous button placement under endoscopic control as a safe, minimally invasive technique. The percutaneous gastrostomy kit, according to the Russell gastrostomy tray (Cook; Cook, Bloomington, IN), was used under cystoscopic control. The U-stitche technique, according to Georgeson, allowed us to secure the bladder to the abdominal anterior wall. A guide was introduced into the bladder through a needle. Three dilatators, respectively 12, 14, and 16 FR, allowed the path for a probe or, immediately, the gastrostomy button (Mic-Key; Ballard Medical Products, Draper, UT). Over 2 years, 10 percutaneous continent vesicostomies were performed for patients with a neurogenic bladder. Patients were from 5 months to 19 years old. The procedure was safe. No major complication was observed except for only minor ones. When intermittent urethral catheterization cannot be established, Mitrofanoff continent urinary diversion seems to be a major surgery for patients and their parents. In addition, for some patients, intermittent bladder emptying may be required for a transitory period. For all these reasons, there is a place for a reversible vesicostomy with a minimally invasive procedure. Button vesicostomy seems to be a good alternative. In this article, we propose a percutaneous technique with an endoscopic control. If this kind of treatment is effective, it may avoid further major surgery. Percutaneous button vesicostomy placement under endoscopic control is safe and feasible and must be evaluated with large series.