CUTANEOUS VESICOSTOMY IN THE YOUNG-CHILD - INDICATIONS AND RESULTS

With newer methods of managing lower urinary tract pathology in the yo ung child, the role of cutaneous vesicostomy may be changing. This pro mpted a review of 50 consecutive patients treated with initial vesicos tomy at our center over a ten-year period. These children underwent ve sicostomy diversion at a median age of 5.8 months and, of the 34 vesic ostomies which have been subsequently closed, for a median duration of twenty-five months. Our indications agree with series reported previo usly and include patients with meningomyelocele, posterior urethral va lves, or other forms of congenital or acquired lower urinary tract ano maly or dysfunction, along with complicating factors such as vesicoure teral reflux, recurrent infections, and/or renal deterioration. Howeve r, we also have identified a major group-those with primary gross vesi coureteral reflux-not previously included in detail. Follow-up average d thirty-eight months. Improvement or stabilization of upper urinary t racts was achieved in over 90 percent of cases, and this trend continu ed after vesicostomy closure. As well, cutaneous vesicostomy allowed u reteral dilation to normalize, decreasing the degree of reflux and nee d for subsequent ureteral tapering and reimplantation at closure. Fina lly, though our stomal revision rate of 20 percent is high, modified t echniques are being pursued.