New application of the gastrostomy button for clinical and urodynamic evaluation before vesicostomy closure.
OBJECTIVE
We report use of the Bard gastrostomy button to occlude vesicostomy and provide access for intermittent catheterization before closure in children with vesicostomy. Evaluation of bladder function in such children usually relies on radiographic and urodynamic studies, which may fail to predict bladder compliance, emptying and continence after closure.


METHODS
Buttons were placed before vesicostomy closure in 1 boy with the prune-belly syndrome and 2 girls with cloacal anomalies 2.5 to 10 years old. The patients had undergone vesicostomy using the Blocksom technique soon after birth because of urinary infection, and impairment of bladder emptying and renal function.


RESULTS
With the button in place bladder emptying, compliance, continence and possible upper tract changes could be evaluated during several weeks. Button coaptation to the vesicostomy was complete with no urine leakage around the device, allowing easy intermittent drainage through its channel. After 4 weeks the buttons did not have any encrustation or lithiasis and patients were free of urinary infection. Vesicostomy was closed in each patient and the period of temporary closure provided by the button was predictive of future bladder behavior.


CONCLUSIONS
This new and original application of the gastrostomy button as a temporary vesicostomy closure may be useful to predict the clinical and urodynamic responses of a defunctionalized bladder in patients with vesicostomy who are candidates for urinary undiversion.
de Badiola
F I
FI
Department of Pediatric Urology, Hospital Italiano, Buenos Aires, Argentina.
Denes
E D
ED
Ruiz
E
E
Smith
C
C
Bukowski
T
T
González
R
R
D002648:Child; D002675:Child, Preschool; D002988:Cloaca / Q000002:abnormalities / Q000601:surgery; D003559:Cystostomy / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation; D006801:Humans; D008297:Male; D011535:Prune Belly Syndrome / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D014563:Urodynamics