Has vesicostomy a role in the neuropathic bladder?

Area of Science:

• Urology
• Pediatric Surgery
• Nephrology

Background:

• Neuropathic bladder dysfunction often leads to upper urinary tract deterioration.
• Intermittent self-catheterization is the preferred management but not always feasible.
• Vesicostomy offers a surgical drainage option for selected patients.

Purpose of the Study:

• To evaluate the efficacy of vesicostomy in preserving renal function in patients with neuropathic bladders and deteriorating upper tracts.
• To assess the long-term outcomes of vesicostomy in this patient population.

Main Methods:

• Retrospective study of 16 patients (1980-1987) with neuropathic bladders undergoing vesicostomy.
• Patients had documented urinary tract infections, hydronephrosis/hydroureter, and often reflux or impaired renal function.
• Data collected included patient demographics, underlying conditions, pre- and post-operative renal function, and radiological parameters.

Main Results:

• Vesicostomy arrested renal tract deterioration in all patients.
• Fifteen patients demonstrated structural or functional improvement; one stabilized.
• Late closure of vesicostomies led to disimprovement in renal parameters, underscoring the need for continuous drainage.
• Patient acceptance of the procedure was favorable.

Conclusions:

• Vesicostomy is an effective management strategy for preserving renal function in patients with neuropathic bladders and deteriorating upper tracts when intermittent self-catheterization is not a viable option.
• The procedure demonstrates good patient acceptance and leads to significant renal functional improvement.
• Maintaining urinary diversion via vesicostomy is crucial for sustained renal health in this population.