Umbilical rotation: a new technique for the cutaneous fixation of continent catheterizable vesicostomies.
OBJECTIVE
For cutaneous fixation of the continent catheterizable vesicostomy we present a new technique, in which the umbilicus is rotated caudally by 180° and the catheterizable channel is sutured to the umbilical cone. This procedure reduces the distance between the stoma entrance and the bladder.


METHODS
Between 2001 and 2008, 67 patients underwent construction of a continent catheterizable vesicostomy. In 82% (n = 55), this was an appendicovesicostomy according to the Mitrofanoff principle. For 21 of these patients, later in the series (2005 onwards), the procedure involved rotation of the umbilicus. We evaluated cosmetic outcome and channel-related complication rates and compared the results between the two groups, with and without umbilical rotation.


RESULTS
The overall complication rate was 22.4% (n = 15); stoma stenosis occurred in eight cases. In the majority of cases with complications, endoscopic treatment was sufficient. The complication rate was significantly lower in the group with umbilical rotation compared to the other group (14.3% vs 26.1%, P < 0.02).


CONCLUSIONS
Umbilical rotation always enables cutaneous implantation of the vesicostomy in the umbilical pit and is a safe and straightforward procedure.
Division of Paediatric Urology, Clinic of Urology, University of Erlangen-Nürnberg, Krankenhausstrasse 12-14, D-91045 Erlangen, Germany. eva.weikert@uk-erlangen.de
Eva
E
Weikert
Susanne
S
Kraske
Günter E
GE
Schott
Bernd
B
Wullich
Karin
K
Hirsch
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003559:Cystostomy / Q000009:adverse effects / Q000379:methods*; D062109:Dermatologic Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007813:Laparotomy / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012399:Rotation; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery*; D014546:Urinary Catheterization / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D014555:Urination Disorders / Q000601:surgery*; D014564:Urogenital Abnormalities / Q000601:surgery