title: Button vesicostomy: 13 years of experience.
abstract: BACKGROUND
  Over recent years the button vesicostomy has become an alternative management option in children with poor bladder emptying, when clean intermittent catheterisation (CIC) cannot be initiated for reasons of age, sensation, or urethral anatomy. This study reviews recent experience of this technique and evaluates its use.
  
  
  METHODS
  Retrospective review of patients who had a button vesicostomy to permit bladder drainage between 1998 and 2011.
  
  
  RESULTS
  Thirty children underwent button vesicostomy insertion aged between 4 days and 16 years. Indications were neuropathic bladders (n = 15), congenital hypotonic bladders (n = 6), functional bladder disorders (n = 5), and post-obstruction bladders (n = 4). The median length of use was 11 months; however, 7 patients still have the button in situ. Minor complications (n = 12) included transient leakage, wound infection, and overgranulation. Major complications included 2 UTIs, 1 device failure, and 2 significant leaks, requiring revision of the tract and removal of the button.
  
  
  CONCLUSIONS
  The button vesicostomy is a suitable and safe technique for use in the short- and medium-term. The procedure has minimal morbidity and therefore is acceptable to families. It has a wide scope, including patients with a neuropathic bladder as an alternative to CIC and where temporary drainage is required until bladder function can recover.
authors.affiliation: Department of Paediatric Surgery, Oxford Radcliffe NHS Trust, Oxford Children's Hospital, Headley Way, Oxford, OX3 9DU, UK. Electronic address: catherinebradshaw@doctors.net.uk.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Bradshaw
authors.affiliation: Department of Urology, Oxford Radcliffe NHS Trust, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK. Electronic address: robhrgray@gmail.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Gray
authors.affiliation: Department of Paediatric Surgery, Oxford Radcliffe NHS Trust, Oxford Children's Hospital, Headley Way, Oxford, OX3 9DU, UK. Electronic address: Angela.Downer@ouh.nhs.uk.
authors.forename: Angela
authors.initials: A
authors.lastname: Downer
authors.affiliation: Department of Paediatric Surgery, Oxford Radcliffe NHS Trust, Oxford Children's Hospital, Headley Way, Oxford, OX3 9DU, UK. Electronic address: rhitchcock@doctors.org.uk.
authors.forename: Rowena
authors.initials: R
authors.lastname: Hitchcock
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003559:Cystostomy / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009123:Muscle Hypotonia; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*
keywords: Clean intermittent catheterisation; Mic-Key button; Neuropathic bladder; Vesicostomy