Vesicostomy revisited: the best treatment for the hostile bladder in myelodysplastic children?
OBJECTIVE
To evaluate the effects of vesicostomy on the urinary tract of myelodysplastic children in whom conservative bladder management with clean intermittent catheterization (CIC) has failed to preserve upper and lower urinary tract function.


METHODS
Sixteen children with myelodysplasia underwent vesicostomy. Indications included worsening hydronephrosis, vesico-ureteric reflux (VUR), recurrent urinary tract infections (UTIs), and increasing renal insufficiency despite CIC and/or difficulty with CIC. The mean (range) age at vesicostomy was 36.5 (9-82) months and the follow-up 7.4 (2-16) years.


RESULTS
Hydronephrosis resolved or improved in 12 of 14 children, the incidence of UTI decreased to one or fewer per year in 10, VUR resolved or improved in nine, and renal function improved or stabilized in six of seven patients. One patient initially presented with renal insufficiency and subsequently required dialysis despite vesicostomy. Complications occurred in three of 15 children, and included stomal stenosis and bladder calculi. The vesicostomy was closed in six patients after a mean of 4.4 (1.5-9) years. Four of these patients required concomitant bladder augmentation.


CONCLUSIONS
Vesicostomy in myelodysplastic children is effective in preventing and/or resolving the deleterious consequences of a 'hostile' bladder. The procedure is uncomplicated, well tolerated, reversible and should be considered in managing children in whom conservative management by CIC has failed.
Morrisroe
Shelby N
SN
Department of Urology, University of California Davis, Sacramento, California 95817, USA.
O'Connor
R Corey
RC
Nanigian
Dana K
DK
Kurzrock
Eric A
EA
Stone
Anthony R
AR
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003559:Cystostomy / Q000379:methods*; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000601:surgery; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000150:complications*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D014552:Urinary Tract Infections / Q000517:prevention & control; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000601:surgery