[Trans-appendicular continent cystostomy in the management of the neurogenic bladder]

The comfort obtained in some cases of neurogenic bladder of the girl, thanks to unsterile self catheterization, and usual absence of septic complications, incite to search for a process which could be used for the boys as well as girls in those cases where urethral catheterization cannot be done. What's more, if the catheterization is easy to achieve even by young children and if the process brings complete dryness, almost perfect conditions of comfort would be achieved. A cystostomy with a continent opening easy to catheterize and associated with a closure of the vesical neck, was the objective. We had the idea to use the appendix in order to create a passage between the skin and the bladder, the tip of the appendix opening into the bladder at the end of an anti-reflux submucosal tunnel and the other end hemmed to the skin. The bladder neck is usually closed in the course of the same operation. From October 1976 to January 1979, 16 children have gone through such a vesicostomy. In two more cases a trans-ureteral cystostomy was created. Five cases were a failure owing to a too small bladder and required a cutaneous diversion. The continence of the vesicostomy is total and the comfort obtained is excellent for the other 13 cases. Some complications result directly from this technique. It concerns more particularly cutaneous fistula (1 case) or with urethral repermeation (2 cases). Other problems, common to all conservative treatments of a neurogenic bladder, are discussed:vesico-renal reflux, dilatation of the upper urinary tract, urinary infections and of course, risk for the renal function. They appear to be related with a small and hypertonic bladder. Obviously these problems must be kept in mind and require a strict selection for the vesicostomy and a strict followup.