Temporary vesicostomy in pediatrics: What are the potential predictors of functional and morphological improvement of the upper urinary tract?

Published:September 21, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.09.016

      Summary

      Introduction

      Vesicostomy is a simple, well-tolerated, and reversible procedure with few complications that safeguards upper urinary tract (UUT), decreases VUR grade, decreases UTI, and preserves renal function and should be considered in patients with PUV who have undergone prior valve ablation and bladder function not improved, and in myelodysplastic children that do not respond to catheter drainage [
      • Prundente A.
      • Reis O.L.
      • Franca Rde P.
      • Miranda M.
      • Levi D’Ancona C.A.
      Vesicostomy as a protector of upper urinary tract in long-term follow-up.
      ,
      • Rouzrokh M.
      • Mirshemirani A.
      • Khaleghnejad-Tabari A.
      • Sadeghian N.
      • Mohajerzadeh L.
      • Mohkam M.
      Protective temporary vesicostomy for upper urinary tract problems in children: a five-year experience.
      ,
      • Lee M.W.
      • Greenfield S.P.
      Intractable high-pressure bladder in female infants with spina bifida: clinical characteristics and use of vesicostomy.
      ,
      • Morrisroe S.N.
      • O'Connor R.C.
      • Nanigian D.K.
      • Kurzrock E.A.
      • Stone A.R.
      Vesicostomy revisited: the best treatment for the hostile bladder in myelodysplastic children?.
      ].

      Objective

      We evaluated the temporary vesicostomy as a safeguard of the UUT in children with bladder outlet obstruction, bladder dysfunction, and high-grade VUR with sepsis and assessed the possible predictors of the UUT's morphological and functional improvement since these have been rarely explored in previous reviews.

      Study design

      We evaluated the outcome and complications of temporary vesicostomy who were operated on 69 children at our center from 2014 to 2019.

      Result

      There were 63 (91.3%) boys and 6 (8.7%) girls who underwent vesicostomy at a mean age of 15.38 ± 2.74 months old. Twenty-nine cases (42%) were diagnosed as primary VUR, 23 (33.3%) had posterior urethral valve (PUV), and 5 (7.2%) had voiding dysfunction, while 12 (17.4%) were neurogenic bladder. Twenty-five (36.2%) patients were diagnosed prenatally and the remainder (44, 63.8%) postnatally. All patients were evaluated at least one year postoperatively. UTI was diagnosed in all cases before vesicostomy; 47 (68.1%) had a single episode of UTI and 22 (31.9%) had recurrent episodes of UTI. Mean serum creatinine was 1.75 ± 0.13 (0.7–4.8) mg/dl. Serum creatinine and the rate of UTI significantly improved (p-value <0.01). Seven (10.1%) cases were complicated with prolapse, 8 (11.6%) with stenosis, and 10 (14.5%) with peristomal dermatitis, all of them were males.

      Discussion

      About 75.4% of cases developed morphological improvement, while 24.6% of cases not improved (p-value = 0.0001). Improvement or stability of glomerular filtration rate (GFR) was seen in 84.1%, while 15.9% deteriorated GFR (p-value = 0.0001). This deterioration is associated with prenatal renal dysplasia. Age less than one year, abdominal swelling, severe HUN, grade V VUR and recurrent UTI before vesicostomy all independently affect functional improvement after vesicostomy.

      Conclusion

      Vesicostomy is a simple, reversible, and well-tolerated surgery with few complications that is indicated in children with bladder outlet obstruction, bladder dysfunction, and high-grade VUR to protect UUT, improve renal function, decrease VUR, hydronephrosis, and febrile UTI. Age less than one year, abdominal swelling, severe HUN, grade V VUR and recurrent UTI before vesicostomy all were predictors that independently affect morphological and functional outcomes after vesicostomy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Prundente A.
        • Reis O.L.
        • Franca Rde P.
        • Miranda M.
        • Levi D’Ancona C.A.
        Vesicostomy as a protector of upper urinary tract in long-term follow-up.
        Urol J. 2009; 6: 96-100
        • Rouzrokh M.
        • Mirshemirani A.
        • Khaleghnejad-Tabari A.
        • Sadeghian N.
        • Mohajerzadeh L.
        • Mohkam M.
        Protective temporary vesicostomy for upper urinary tract problems in children: a five-year experience.
        Iran J Pediatr. 2013; 23: 648
        • Lee M.W.
        • Greenfield S.P.
        Intractable high-pressure bladder in female infants with spina bifida: clinical characteristics and use of vesicostomy.
        Urology. 2005; 65: 568-571
        • Morrisroe S.N.
        • O'Connor R.C.
        • Nanigian D.K.
        • Kurzrock E.A.
        • Stone A.R.
        Vesicostomy revisited: the best treatment for the hostile bladder in myelodysplastic children?.
        BJU Int. 2005; 96: 397-400
        • Blocksom Jr., B.H.
        Bladder pouch for prolonged tubeless cystostomy.
        J Urol. 1957; 78: 398-401
        • Michie A.J.
        • Borns P.
        • Ames M.D.
        Improvement following tubeless suprapubic cystostomy of myelomeningocele patients with hydronephrosis and recurrent acute pyelonephritis.
        J Pediatr Surg. 1966; 1: 347-352
        • Duckett Jr., J.W.
        Cutaneous vesicostomy in childhood. The Blocksom technique.
        Urol Clin North Am. 1974; 1: 485-495
        • Hutcheson J.C.
        • Cooper C.S.
        • Canning D.A.
        • Zderic S.A.
        • Snyder 3rd, H.M.
        The use of vesicostomy as permanent urinary diversion in the child with myelomeningocele.
        J Urol. 2001; 166: 2351-2353
        • Nanda M.
        • Bawa M.
        • Narasimhan K.
        Mini-vesicostomy in the management of PUV after valve ablation.
        J Pediatr Urol. 2012; 8: 51-54
        • Chua M.E.
        • Ming J.M.
        • Carter S.
        • El Hout Y.
        • Koyle M.A.
        • Noone D.
        • et al.
        Impact of adjuvant urinary diversion versus valve ablation alone on progression from chronic to end stage renal disease in posterior urethral valves: a single institution 15- year time-to-event analysis.
        J Urol. 2018; 199: 824-830
        • Zoheiry M.
        • Shoukry A.
        • Abdelraouf H.
        • Eissa M.
        707 Comparative study between vesicostomy and posterior urethral valve fulgeration in uraemic infants.
        Eur Urol Suppl. 2016; 15: e707
        • Hosseini S.M.
        • Zarenezhad M.
        • Kamali M.
        • Gholamzadeh S.
        • Sabet B.
        • Alipour F.
        Comparison of early neonatal valve ablation with vesicostomy in patient with posterior urethral valve.
        Afr J Paediatr Surg: AJPS (Asian J Plant Sci). 2015; 12: 270
        • Podesta M.L.
        • Ruarte A.
        • Herrera M.
        • Medel R.
        • Castera R.
        Bladder functional outcome after delayed vesicostomy closure and antireflux surgery in young infants with ‘primary’vesicoureteric reflux.
        BJU Int. 2001; 87: 473-479
        • Queipo Zaragoza´ J.A.
        • Domı´nguez Hinarejos C.
        • Serrano Durba´ A.
        • Estornell Moragues F.
        • Martı´nez Verduch M.
        • Garcı´a Ibarra F.
        Vesicostomy in children. Our experience with 43 patients.
        Actas Urol Esp. 2003 Jan; 27: 33-38https://doi.org/10.1016/s0210-4806(03)72873-3
        • Sharifiaghdas F.
        • Mirzaei M.
        • Nikravesh N.
        Can transient resting of the bladder with vesicostomy reduce the need for a major surgery in some patients?.
        J Pediatr Urol. 2019 aug; 15: P379 E1-P379E8https://doi.org/10.1016/j.jpurol.2019.03.026
        • Westney O.L.
        The neurogenic bladder and incontinent urinary diversion.
        Urol Clin North Am. 2010; 37: 581https://doi.org/10.1016/j.ucl.2010.07.003
        • Lukong C.S.
        • Ameh E.A.
        • Mshelbwala P.M.
        • Jabo B.A.
        • Gomna A.
        • Anumah M.A.
        • et al.
        Role of vesicostomy in the management of posterior urethral valve in Sub-Saharan Africa.
        J Pediatr Urol. 2014 Feb; 10: 62-66
        • Vastyan A.M.
        • Pinter A.B.
        • Farkas A.
        • Vajda P.
        • Somogyi R.
        • Juhasz Z.
        Cutaneous vesicostomy revisited–the second 15 years.
        Eur J Pediatr Surg. 2005 Jun; 5 (3): 170-174https://doi.org/10.1055/s-2005-837609