Protective Temporary Vesicostomy for Upper Urinary Tract Problems in Children: A Five-Year Experience

Alireza  Mirshemirani; Mohsen  Rouzrokh; Ahmad Khaleghnejad-Tabari; Naser  Sadeghian; Leily Mohajerzadeh; Maesomeh Mohkam

IJ Pediatrics

The Scientific Journal of Growth & Development Research Center

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Protective Temporary Vesicostomy for Upper Urinary Tract Problems in Children: A Five-Year Experience

Author(s):

Alireza Mirshemirani^1,*,

Mohsen Rouzrokh²,

Ahmad Khaleghnejad-Tabari³,

Naser Sadeghian⁴,

Leily Mohajerzadeh⁵,

Maesomeh Mohkam⁶

IJ Pediatrics:Vol. 23, issue 6

Published online:Nov 09, 2013

Article type:Research Article

Received:Oct 23, 2012

Accepted:Jun 27, 2013

How to Cite:Alireza MirshemiraniMohsen RouzrokhAhmad Khaleghnejad-TabariNaser SadeghianLeily MohajerzadehMaesomeh Mohkamet al.Protective Temporary Vesicostomy for Upper Urinary Tract Problems in Children: A Five-Year Experience.Iran J Pediatr.23(6):null-null.

Abstract

Objective: Temporary vesicostomy is a urinary diversion procedure for patients with upper urinary tract (UUT) dilatation, secondary to bladder outlet obstruction or dysfunction. The aim of this study was to evaluate our experience in children undergoing such diversion, analyzing its efficacy to prevent urinary tract infection (UTI), improve or resolve hydronephrosis, stabilize or improve kidney function and restore the health of UUT. Methods: In this retrospective study, patients who had vesicostomy by Blocksom technique due to bladder outlet obstruction or dysfunction were evaluated in Mofid Children's Hospital (in Tehran) from March 2007 to March 2012. The reason for applying this procedure was failure in clinical treatment. Data regarding gender, age, diagnosis, time of any surgical intervention, associated anomalies, primary/secondary complications and mortality were collected using a questionnaire, and evaluated by giving a grade that ranged from 0 (worst) to 10 (best) based on Lickert's scale. Findings: From a total number of 53 patients, (88.7% male and 11.3% female) with a mean age of 225 days, 66% had posterior urethral valve and 16 (30%) neurogenic bladder. UTI was present in all cases, hydronephrosis in 52 (98.1%), and vesico-ureteral reflux only in 45 (84.9%) patients. Valve ablation was performed in 17 cases, and clean intermittent catheterization in14 patients which were unsuccessful. We performed vesicostomy in all patients. Mortality rate was 7.5%. Vesicostomy was closed in 35 patients. Cure rate was 85% in UTI, 82.7% in hydronephrosis, 80% in VUR, and 86.5% in kidney function. Conclusion: Vesicostomy is a simple procedure that protects upper urinary tract, decreases hydronephrosis, and improves kidney function. The procedure is well tolerated and reversible, with less complication and should be considered in children in whom conservative and medical treatment has failed.

Keywords

Vesicostomy

Urinary Tract Infection

Protection

Voiding Dysfunction

Vesico-Ureteral Reflux

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