Vesico-cutaneous fistula: a simple method for continent urinary diversion

Area of Science:

• Urology
• Pediatric Surgery
• Reconstructive Urology

Background:

• Patients with lower urinary tract anomalies or neurogenic disorders often experience voiding difficulties.
• Clean intermittent catheterization (CIC) is a common bladder drainage method but can be painful or impossible in cases of urethral stricture.
• Existing surgical solutions like Mitrofanoff conduits have complex techniques and complications, while vesicostomies can lead to urine leakage and skin irritation.

Purpose of the Study:

• To evaluate the efficacy and safety of a vesico-cutaneous fistula as a method for clean intermittent catheterization (CIC).
• To assess the vesico-cutaneous fistula as a potential alternative to more complex urinary diversion techniques.

Main Methods:

• Six patients with urethral stricture or neurogenic bladder underwent creation of a vesico-cutaneous fistula for CIC between 1998 and 2013.
• The fistula was surgically created at the bladder dome, with the muscle layer sutured to the skin.
• Post-operative management included catheterization, regular CIC with feeding tubes, and temporary stenting to prevent stoma stricture and closure.

Main Results:

• Follow-up ranged from 6 months to 16 years, with all patients showing improved hydronephrosis.
• Five patients experienced decreased urinary tract infection (UTI) frequency, and five maintained normal renal function.
• No patient reported painful catheterization; CIC became easy, even for young children, with only one patient experiencing occasional mild urine leakage.

Conclusions:

• The vesico-cutaneous fistula is a simple, effective, and well-tolerated procedure for CIC.
• This method offers a viable alternative or transitional step for patients requiring continent urinary diversion, potentially avoiding complications associated with other techniques.