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Vesicostomy revisited: the best treatment for the hostile bladder in myelodysplastic children?
Author(s) -
Morrisroe Shelby N.,
O'Connor R. Corey,
Nanigian Dana K.,
Kurzrock Eric A.,
Stone Anthony R.
Publication year - 2005
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05638.x
Subject(s) - medicine , enuresis , urinary system , hydronephrosis , surgery , bladder augmentation , reflux , stenosis , incidence (geometry) , upper urinary tract , urinary diversion , urinary bladder , urology , cystectomy , bladder cancer , cancer , optics , physics , disease
Vesicostomy is a well‐known management of the neuropathic bladder in children, and authors from Sacramento describe their experience with this in what they very appropriately name the “hostile bladder” of myelodysplastic children.Other papers in this section suggest that inguinal hernia in female infants should act as a cue to check the sex chromosomes, evaluate nocturnal enuresis in children at 7.5 years old, and describe the efficacy of tolterodine as a first‐line treatment for non‐neurogenic voiding dysfunction in children.OBJECTIVE To evaluate the effects of vesicostomy on the urinary tract of myelodysplastic children in whom conservative bladder management with clean intermittent catheterization (CIC) has failed to preserve upper and lower urinary tract function. PATIENTS AND METHODS Sixteen children with myelodysplasia underwent vesicostomy. Indications included worsening hydronephrosis, vesico‐ureteric reflux (VUR), recurrent urinary tract infections (UTIs), and increasing renal insufficiency despite CIC and/or difficulty with CIC. The mean (range) age at vesicostomy was 36.5 (9–82) months and the follow‐up 7.4 (2–16) years. RESULTS Hydronephrosis resolved or improved in 12 of 14 children, the incidence of UTI decreased to one or fewer per year in 10, VUR resolved or improved in nine, and renal function improved or stabilized in six of seven patients. One patient initially presented with renal insufficiency and subsequently required dialysis despite vesicostomy. Complications occurred in three of 15 children, and included stomal stenosis and bladder calculi. The vesicostomy was closed in six patients after a mean of 4.4 (1.5–9) years. Four of these patients required concomitant bladder augmentation. CONCLUSIONS Vesicostomy in myelodysplastic children is effective in preventing and/or resolving the deleterious consequences of a ‘hostile’ bladder. The procedure is uncomplicated, well tolerated, reversible and should be considered in managing children in whom conservative management by CIC has failed.