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New application of the gastrostomy button for clinical and urodynamic evaluation before vesicostomy closure
F I de Badiola1, E D Denes, E Ruiz
1Department of Pediatric Urology, Hospital Italiano, Buenos Aires, Argentina.
Insights
A gastrostomy button can temporarily close a vesicostomy, allowing doctors to assess bladder function before final closure. This method helps predict bladder behavior after surgery in children with urinary anomalies.
Area of Science:
- Pediatric Urology
- Surgical Innovation
Background:
- Vesicostomy is a surgical procedure to divert urine in children with complex bladder anomalies.
- Assessing bladder function before closure is crucial but challenging with traditional methods.
Observation:
- A gastrostomy button was used to temporarily occlude vesicostomies in three children.
- This allowed for evaluation of bladder emptying, compliance, and continence over several weeks.
Findings:
- The gastrostomy button provided complete occlusion without leakage, facilitating intermittent catheterization.
- Patients remained infection-free, and the button showed no signs of encrustation or stones.
- The period with the button in place accurately predicted bladder function post-closure.
Implications:
- This novel use of a gastrostomy button offers a reliable method to predict clinical and urodynamic outcomes.
- It aids in planning urinary undiversion for children with vesicostomies.
- This technique enhances the management of complex pediatric lower urinary tract conditions.
Purpose:
We report use of the Bard gastrostomy button to occlude vesicostomy and provide access for intermittent catheterization before closure in children with vesicostomy. Evaluation of bladder function in such children usually relies on radiographic and urodynamic studies, which may fail to predict bladder compliance, emptying and continence after closure.
Materials And Methods:
Buttons were placed before vesicostomy closure in 1 boy with the prune-belly syndrome and 2 girls with cloacal anomalies 2.5 to 10 years old. The patients had undergone vesicostomy using the Blocksom technique soon after birth because of urinary infection, and impairment of bladder emptying and renal function.
Results:
With the button in place bladder emptying, compliance, continence and possible upper tract changes could be evaluated during several weeks. Button coaptation to the vesicostomy was complete with no urine leakage around the device, allowing easy intermittent drainage through its channel. After 4 weeks the buttons did not have any encrustation or lithiasis and patients were free of urinary infection. Vesicostomy was closed in each patient and the period of temporary closure provided by the button was predictive of future bladder behavior.
Conclusions:
This new and original application of the gastrostomy button as a temporary vesicostomy closure may be useful to predict the clinical and urodynamic responses of a defunctionalized bladder in patients with vesicostomy who are candidates for urinary undiversion.