Vesicocutaneous fistula: a better way to conduct clean intermittent catheterization

Abstract

Clean intermittent catheterization (CIC) is indicated for the management of voiding disability. Urethral catheterization through nature route could be problematic. Vesicocutaneous fistula (VCF) can be created as a continent urinary stoma to perform CIC. We retrospectively reviewed patients with incomplete bladder emptying who performed CIC through VCF from January 1997 to December 2017. The VCF was created similar to vesicostomy without suture the bladder mucosa to the skin. Nineteen patients including 10 boys and 9 girls underwent VCF at a mean age of 10.6 years (range 6 days to 22.4 years). The mean follow-up period was 4.2 years. The mean daily number of catheterizations was 4.4. Eight out of 10 teenage patients with VCF performed self-CIC. With regular CIC through VCF, the frequency of urinary tract infection decreased and the renal function was preserved. Complications included peristomal granulation (n=9), difficult catheter insertion (n=4) which resolved after sequential dilation in 2 weeks, and revision of VCF in one patient after spontaneous obliteration of VCF. These stoma related problems happened before fistula tract maturation which usually takes 6 months. Two patients had minor urine leak (minimal amount, once to twice a week). Three adolescents who conducted CIC through nature Vecisocutaneous fistula is a simple procedure with minimal morbidity. It provides a continent route to perform CIC. Complication of VCF is often minor and resolved under proper management.