title: Continent Catheterizable Vesicostomy: An Alternative Surgical Modality for Pediatric Patients With Large Bladder Capacity.
abstract: OBJECTIVE
  To present a modified technique and early outcomes of a continent catheterizable vesicostomy in pediatric patients with either flaccid neurogenic bladder or intractable voiding dysfunction and large capacity bladder.
  
  
  METHODS
  Six patients underwent the procedure from October 2014 to December 2015. A 4-cm Pfannenstiel incision was made, avoiding intraperitoneal dissection. After adequate mobilization, a 2-cm vertical flap at the dome of the bladder was identified and tubularized over a 12Fr catheter with 4-0 vicryl suture. The tubularized flap was then intussuscepted into the bladder with four 4-0 polydioxanone sutures, creating a continent mechanism. The catheterizable channel was then tunneled to the umbilicus, the channel ostomy matured, and the cystotomy closed in two layers.
  
  
  RESULTS
  The median patient age was 8 (interquartile range [IQR] 12) years. All patients had urinary dysfunction requiring drainage from etiologies that included Eagle-Barrett syndrome (n = 2), Noonan syndrome (n = 1), Lennox-Gastaut syndrome (n = 1), and Spina bifida (n = 2). Median hospital length of stay was 8 (IQR 3) days. One patient had a superficial wound infection treated with antibiotics, and 1 patient required balloon dilation of the catheterizable channel at 3 months postoperatively, secondary to difficulty self-catheterizing. Five patients were successfully self-catheterizing at last follow-up. Median follow-up was 6 (IQR 5) months and there were no intra- or perioperative complications.
  
  
  CONCLUSIONS
  Continent catheterizable vesicostomy is a novel technique for urinary drainage in patients with large bladder capacity that spares use of the appendix or ileum. Early results are encouraging, providing a catheterizable channel through the umbilicus without urinary leakage between catheterization.
authors.affiliation: Department of Surgery, Section of Urology, Medical College of Georgia-Augusta University, Augusta, GA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Peard
authors.affiliation: Department of Surgery, Section of Urology, Medical College of Georgia-Augusta University, Augusta, GA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Fox
authors.affiliation: College of Allied Health Sciences, Medical Illustration, Augusta University, Augusta, GA.
authors.forename: William M
authors.initials: WM
authors.lastname: Andrews
authors.affiliation: Department of Surgery, Section of Urology, Medical College of Georgia-Augusta University, Augusta, GA.
authors.forename: Roger
authors.initials: R
authors.lastname: Chen
authors.affiliation: Department of Surgery, Section of Urology, Medical College of Georgia-Augusta University, Augusta, GA.
authors.forename: Casey O
authors.initials: CO
authors.lastname: McCraw
authors.affiliation: Department of Surgery, Section of Urology, Medical College of Georgia-Augusta University, Augusta, GA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Klaassen
authors.affiliation: Department of Surgery, Section of Urology, Medical College of Georgia-Augusta University, Augusta, GA. Electronic address: uroprofdn@gmail.com.
authors.forename: Durwood E
authors.initials: DE
authors.lastname: Neal
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003559:Cystostomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D001743:Urinary Bladder / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000601:surgery*; D014546:Urinary Catheterization; D014555:Urination Disorders / Q000601:surgery*