Background
Cutaneous vesicostomy is often cited as a temporizing measure prior to future undiversion and reconstruction. However, it may also be used as a more permanent diversion strategy in select patient populations. When counseling on the expected outcomes of performing a vesicostomy, the ability to prognosticate the typical duration before undiversion and the likelihood of using a vesicostomy as long-term urinary diversion may be important to patients and families.
Methods
A retrospective review was performed for all patients seen in the urology clinic from January 2009 to October 2023 with a diagnosis of either myelomeningocele (MMC) or posterior urethral valves (PUV). Patients that had a history of vesicostomy were identified along with timing of vesicostomy closure at last known follow-up. Kaplan-Meier curves were developed to compare the rates of vesicostomy reversal over time between patients with MMC and PUV. Patient demographics and characteristics were also compared between the groups.
Results
Sixty-eight patients who had undergone creation of a vesicostomy were identified (n=35 with MMC and n=33 with PUV). Overall, the median age at time of vesicostomy creation was 1.82 years (interquartile range [IQR] 0.62-3.14 years). Patients with MMC were older than those with PUV at time of vesicostomy creation (MMC = 2.54 years, PUV = 0.73 years; p<0.001). Median age at last follow up was 9.15 years (IQR 4.91-15.65 years). For those who underwent vesicostomy closure, median time with a vesicostomy was 3.40 years (IQR 2.04-4.27 years). Length of time with vesicostomy prior to closure did not differ between the groups (p=0.30). The overall rate of patients who still had a vesicostomy at last follow-up was 54% . 71% of patients with MMC still had their vesicostomy at last follow-up compared to 36% of patients with PUV (p=0.004 ). For all patients, the rate of vesicostomy revision was 16% at a median time of 5.2 months from vesicostomy creation (IQR 4.2-12 months).
Conclusions
The utilization and longevity of a vesicostomy appears to differ between patient populations. For the majority of patients with MMC, a vesicostomy is utilized for long-term bladder management. This is important to consider in patient counseling as a vesicostomy may not be as temporary of a solution as previously thought in select patient populations.
