title: Protective temporary vesicostomy for upper urinary tract problems in children: a five-year experience.
abstract: OBJECTIVE
  Temporary vesicostomy is a urinary diversion procedure for patients with upper urinary tract (UUT) dilatation, secondary to bladder outlet obstruction or dysfunction. The aim of this study was to evaluate our experience in children undergoing such diversion, analyzing its efficacy to prevent urinary tract infection (UTI), improve or resolve hydronephrosis, stabilize or improve kidney function and restore the health of UUT.
  
  
  METHODS
  In this retrospective study, patients who had vesicostomy by Blocksom technique due to bladder outlet obstruction or dysfunction were evaluated in Mofid Children's Hospital (in Tehran) from March 2007 to March 2012. The reason for applying this procedure was failure in clinical treatment. Data regarding gender, age, diagnosis, time of any surgical intervention, associated anomalies, primary/secondary complications and mortality were collected using a questionnaire, and evaluated by giving a grade that ranged from 0 (worst) to 10 (best) based on Lickert's scale.
  
  
  RESULTS
  From a total number of 53 patients, (88.7% male and 11.3% female) with a mean age of 225 days, 66% had posterior urethral valve and 16 (30%) neurogenic bladder. UTI was present in all cases, hydronephrosis in 52 (98.1%), and vesico-ureteral reflux only in 45 (84.9%) patients. Valve ablation was performed in 17 cases, and clean intermittent catheterization in14 patients which were unsuccessful. We performed vesicostomy in all patients. Mortality rate was 7.5%. Vesicostomy was closed in 35 patients. Cure rate was 85% in UTI, 82.7% in hydronephrosis, 80% in VUR, and 86.5% in kidney function.
  
  
  CONCLUSIONS
  Vesicostomy is a simple procedure that protects upper urinary tract, decreases hydronephrosis, and improves kidney function. The procedure is well tolerated and reversible, with less complication and should be considered in children in whom conservative and medical treatment has failed.
authors.affiliation: Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Rouzrokh
authors.affiliation: Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mirshemirani
authors.affiliation: Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Khaleghnejad-Tabari
authors.affiliation: Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Naser
authors.initials: N
authors.lastname: Sadeghian
authors.affiliation: Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Leily
authors.initials: L
authors.lastname: Mohajerzadeh
authors.affiliation: Pediatric Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Maesomeh
authors.initials: M
authors.lastname: Mohkam
keywords: Protection; Urinary Tract Infection; Vesico-Ureteral Reflux; Vesicostomy; Voiding Dysfunction