Vesico-cutaneous fistula: a simple method for continent urinary diversion.
INTRODUCTION
Patients with lower urinary tract anomalies or neurogenic disorders often suffer from voiding difficulties. Clean intermittent catheterization (CIC) is effective for bladder drainage; however, this is often painful. Transurethral catheterization is also impossible in patients with urethral stricture. A Mitrofanoff conduit may solve some of these problems, but a few disadvantages have been reported, including: difficult surgical techniques and frequent operative complications. A vesicostomy is easy to perform but persistent urine leak over the abdomen and diaper rash can be annoying. A better way to achieve continent urinary diversion is indicated.


METHOD
Between December 01 1998 and December 31 2013, six patients underwent a vesico-cutaneous fistula for CIC. The etiologies included urethral stricture (n=2) and neurogenic bladder (n=4). The fistula was created at the bladder dome with only the muscle layer of the bladder sutured to the skin. A Foley catheter was left in place for at least two weeks to prevent stoma stricture. After removing the Foley catheter, regular CIC from the fistula was performed every 2 h during the daytime with a Fr. 10-12 feeding tube, depending on the patient's age. Further stenting during the night in the first six months was necessary to prevent early closure of the fistula. Patients were followed with periodic renal ultrasonography, blood tests and urinalysis in the outpatient department.


RESULTS
Follow-up ranged from 6 months to 16 years. All patients showed improvements in hydronephrosis. Decreased UTI frequency was seen in five patients. Renal function was normal in five patients, whilst the other suffered from chronic renal failure preoperatively. Only one patient had occasional mild urine leakage from the stoma at night, which was once in two weeks. No patient experienced painful or difficult catheterization and CIC becomes easy, even by young children.


CONCLUSIONS
The vesico-cutaneous fistula is a simple, effective and tolerable method for CIC. It may be a substitute for or a transition to a Mitrofanoff conduit in some patients.
['Yang|W|W|', 'Chang|P-Y|PY|', 'Lai|J-Y|JY|', 'Cheng|C-H|CH|', 'Tseng|M-H|MH|']
D000293:Adolescent D002648:Child D002675:Child, Preschool D003559:Cystostomy D005260:Female D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D016896:Treatment Outcome D014525:Urethral Stricture D001750:Urinary Bladder, Neurogenic D014546:Urinary Catheterization D014547:Urinary Diversion D013520:Urologic Surgical Procedures D055815:Young Adult
Urinary diversion Urethral stricture Neurogenic bladder Vesical fistula