Suprapubic vesicostomy buttons: Indications, complications and bladder outcomes.

Abstract

Introduction: Vesicostomy button drainage is a recognised alternative to clean intermittent catheterization (CIC) in children with urethral obstruction, sensate urethra or neurological/behavioural issues.

Aim: To report the indications, complications and long-term bladder functional outcomes in a 15-year cohort of patients with button vesicostomy.

Materials and methods: AMT Mini one gastrostomy button^R was inserted via a surgical vesicostomy, or percutaneously under cystoscopic guidance. Retrospective data included demographics, indications, complications, and long-term bladder capacity/emptying pre-post-button removal.

Results: 29 children (23 males) underwent vesicostomy button insertion at 3.5 (0.5-14.5) years. Diagnosis was neurogenic (11), bladder outlet obstruction (9), cloaca/urogenital sinus (3), anorectal malformation (ARM) (2), other bladder dysfunction (3) and diversion (1). There were no short-term complications. UTI occurred in 31 %, leakage in 28 % and blockage in 7 %. At a median of 10 (2-18) years, 14 (48 %) are still on button drainage; 6 (21 %) progressed to Mitrofanoff catheterisation. In 9 (31 %) who no longer require the button, all children were able to void urethrally, with good emptying, at 4.5 (1-7) years follow-up.

Discussion: Continent vesicostomy allows toilet-training and improved quality of life. We estimated that the cost of a button vesicostomy and tubing approximates £1502 per year. 5-6 Speedicaths per day (costing £38 per pack) cost £2772 per year. Asymptomatic bacterial colonisation does not require antibiotic treatment; it is best avoided by changing the button every 12 weeks. Symptomatic febrile UTI's are commonly secondary to the underlying pathology; we recommend changing the button half-way through the antibiotic treatment course. Leakage was managed by increasing the water in the balloon. Button blockage, commonly due to balloon encrustation, is preventable by regular button changes. Button drainage may be temporary (until bladder dysfunction resolves, or changed to a Mitrofanoff), or a long-term (in life-long neuro-developmental/behavioural issues). The button was no longer required in 9: bladder function improved post spinal cord un-tethering in 3; 2 PUV; 2 ARM; 1 myopathy and 1 diversion. Of note, the button did not appear to affect bladder dynamics with sustained resolution of bladder dysfunction in 31 %. Our main limitation was diversity of pathologies, making comparison of urodynamics more challenging: a larger study with more numbers in each patient group would be the next step.

Conclusion: Suprapubic buttons are a safe second-line bladder drainage option in patients who are unable to CIC. The technique may be a temporary solution where bladder dysfunction may resolve, or until the child is ready for catheterisation via a Mitrofanoff.