[Button vesicostomy in newborn: an alternative of classical cutaneous vesicostomy]

In newborn and infant with functional and/or anatomical lower urinary tract obstruction, the goals of vesicostomy are to achieve a low pressure bladder, an effective bladder drainage and to prevent urinary tract infection and sepsis. Nonetheless, classical vesicostomy is not free from complications. The aim is to describe a surgical technique of button vesicostomy as an alternative of cutaneous vesicostomy.

13 newborn and infant, age between 14 and 60 days (median 20 days), twelve male and one female, underwent button vesicostomy. Twelve patients were neurologically normal and one with neurogenic bladder. Surgical technique of button vesicostomy differs from the classical one; it does not require bladder cupula mobilization, the botton is inserted into the bladder at the urachus insertion without suturing the bladder mucosa to the skin, creating a vesico-cutaneous fistula.

Button vesicostomy was found to be safe and effective in 96%. Stabilization of upper urinary tracts was achieved in all cases. Botton vesicostomy has made it possible to undergo intermittent catheterization through the button before closure of the vesicostomy, as well as performing standard urodynamic studies through the urethra to evaluate bladder function during follow-up and providing objective data for proper undiversion. There were no complications. Vesicostomy was closed at a median age of twenty months, combined with reconstructive procedures, when necessary.

Button vesicostomy has improved the outcome of the classical vesicostomy. It provides an efficient way for lowering the bladder pressure in the absence of complications, making possible to perform urodynamic studies; the evaluation of bladder function is essential prior to the undiversion.