Vesicostomy button: how is it placed, in whom, and how is quality of life affected?

Abstract

Purpose The vesicostomy button has been shown to be a safe and effective bladder management strategy for short- or medium-term use when CIC cannot be instituted. This study reports our use with the vesicostomy button, highlighting the pros and cons of its use and complications. We then compared the quality or life in patients with vesicostomy button to those performing clean intermittent catheterization.Materials and Methods Retrospective chart review was conducted on children who had a vesicostomy button placed between 2011 and 2015. Placement was through existing vesicostomy, open or endoscopically. We then evaluated placement procedure and complications. A validated quality of life questionnaire was given to patients with vesicostomy button and to a matched cohort of patients performing clean intermittent catheterization.Results Thirteen children have had a vesicostomy button placed at our institution in the 4 year period, ages 7 months to 18 years. Indications for placement included neurogenic bladder (5), non-neurogenic neurogenic bladder (3), and valve bladders (5). Five out of 7 placed via existing vesicostomy had leakage around button. None of the endoscopically placed buttons had leakage. Complications were minor including UTI (3), wound infection (1), and button malfunction/leakage (3). QOL was equal and preserved in patients living with vesicostomy buttons when compared to CIC.Conclusion The vesicostomy button is an acceptable alternative to traditional vesicostomy and CIC. The morbidity of the button is quite low. Endoscopic insertion is the optimal technique. QOL is equivalent in patients with vesicostomy button and those who perform CIC.

Permanent cutaneous vesicostomy: a pragmatic approach to safely manage lower urinary tract dysfunction in pediatric patients with chronic and life-limiting conditions and neuropathic bladders

“…hydronephrosis, and improvement of functional outcome after CV for bladder outlet obstruction in patients with CP (11). Although the CV is safe and effective, it should not be considered for all patients with neurogenic bladders who preferably should be decompressed using CIC with or without continent catheterizable stoma (9,10). However, in our particular population of institutionalized long-term care patients, often with other significant comorbidities, those complex procedures are risky and demand special postoperative care (1,5).…”

“…The management of LUTD in this complicated patient category varies and ranges from review and modification of patients’ medications, such as discontinuation of anticholinergic medications or addition of alpha-adrenergic blockers, along with other conservative measures, such as CIC to CV or even more sophisticated alternatives such as the construction of abdominal catheterizable stomas (Mitrofanoff channel). However, they are more complex procedures that require significant involvement of specialized care and CIC ( 9 , 10 ).…”

2023 Canadian Urological Association/ Pediatric Urologists of Canada guideline: Pediatric patients with neurogenic lower urinary tract dysfunction

“…79 A cystostomy button may be an alternative; however, the complication rate (mostly UTI) can be up to 34% within a mean followup of 37 months. 80,81 At an appropriate age, the patient can undergo reconstruction or closure of vesicostomy with a high likelihood of continence. 82 Otherwise, there have been reports of long-term vesicostomy into adulthood with high contentment and low complication; thus, in some well-selected patients, it may be a good long-term approach to prevent infection and upper tract deterioration, with no need for planned re-operation.…”