Cutaneous vesicostomy for temporary urinary diversion in infants

Hydronephrosis in the asymptomatic neonate with myelodysplasia

Early diagnosis and intervention in the child with myelodysplasia can effectively improve and preserve renal function in those newborns presenting with abnormalities at birth or who are at risk for deterioration of renal function from infection, vesicoureteral reflux and/or obstruction. During a 1-year period 10 newborns with myelodysplasia were seen. Hydronephrosis was present in 6, reflux in 3 and urinary tract infection in 3. In each newborn adequate decompression of the bladder and complete resolution of the hydronephrosis were achieved. Uroradiographic evaluation was helpful in determining the best mode of therapy for each individual.

Vesicostomy for the temporary diversion of the urine in small children

Vesicostomy was done as a means of temporary urinary diversion in 16 children less than 3 years old. Adequate urinary drainage was not present in these children yet definitive corrective measures were not considered advisable. The good results achieved sugges that this operation is ideally suited for this purpose.

Cutaneous vesicostomy: a useful form of temporary diversion in children

Urinary diversion is not often required in children. Initial enthusiasm for permanent forms of diversion, especially intestinal conduits, has tempered recently with improved reconstructive techniques and the initiation of intermittent catheterization in the management of neurogenic bladder. However, occasionally, temporary diversion still affords the best means of preserving renal function and allowing ultimate reconstruction in a child with uropathology. In our experience vesicostomy has been a successful and simple procedure for temporary diversion in selected children with vesical or urethral disorders. The technique is simple, tubeless, easy to manage and readily reversible. We have reviewed 24 vesicostomies performed in children at our institution during the last 5 years. The results have been overwhelmingly successful and satisfactory. Cutaneous vesicostomy is our preferred form of diversion in selected children who suffer complications of bladder dysfunction until the potential of the bladder can be determined and a definitive plan of management can be established. The specific surgical technique as well as results and complications are discussed.