title: Vesicostomy as a protector of upper urinary tract in long-term follow-up.
abstract: BACKGROUND
  The aim of this study was to analyze the results of vesicostomy in children as a protector of the upper urinary tract and assess the adjustments taken by the caregivers.
  
  
  METHODS
  Twenty-one children who had undergone vesicostomy with the Blocksom technique were evaluated. Their mean age was 3.7 years (range, < 1 to 10 years). The evaluation consisted of kidney function tests, cystography, and analysis of complications. Twenty parents or caregivers were interviewed about their attitudes towards vesicostomy and its outcomes.
  
  
  RESULTS
  The main causes of the vesical dysfunction were posterior urethral valve in 7 (33.3%) and myelomeningocele in 5 patients (23.8%). Ten children (58.8%) showed improvement and 7 (41,2%) showed cure. Hydronephrosis observed in 17 children was alleviated or cured following the procedure. Kidney function, tested by creatinine clearance calculation, remained stable or improved in 20 patients (95.2%). Episodes of urinary tract infection and vesicoureteral reflux lowered in 8 of 21 (38.1%) and 10 of 14 patients (71.4%), respectively. Subjective evaluation of 20 cases showed that 18 children (90.0%) remained dry during the day and 14 caregivers/parents (70.0%) felt they had acquired the skills necessary to handle a patient with vesicostomy. The mean global rate of satisfaction of the results of the surgery ranging from 0 (worst result) to 10 (best result) was 8.7.
  
  
  CONCLUSIONS
  Vesicostomy is a simple surgery that protects the upper urinary tract, decreases hydronephrosis, and improves kidney function. There was adequate adjustment to vesicostomy and a positive global evaluation as reported by the parents and caregivers.
authors.affiliation: Department of Urology, State University of Campinas, São Paulo, Brazil.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Prudente
authors.forename: Leonardo Oliveira
authors.initials: LO
authors.lastname: Reis
authors.forename: Rodrigo de Paula
authors.initials: Rde P
authors.lastname: França
authors.forename: Márcio
authors.initials: M
authors.lastname: Miranda
authors.forename: Carlos Arturo Levi
authors.initials: CA
authors.lastname: D'ancona
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003559:Cystostomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000517:prevention & control*; D007223:Infant; D007674:Kidney Diseases / Q000517:prevention & control; D007677:Kidney Function Tests; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000517:prevention & control*; D014555:Urination Disorders / Q000175:diagnosis / Q000601:surgery; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000601:surgery