AUTHOR=Vallasciani Santiago , Al Saeedi Ahmed , Khalil Ibrahim A. , Mohamed Reem Babiker , Muneer Eshan , Abdelmaguid Nadra , Pippi Salle Joao Luiz 

TITLE=Permanent cutaneous vesicostomy: a pragmatic approach to safely manage lower urinary tract dysfunction in pediatric patients with chronic and life-limiting conditions and neuropathic bladders

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 12 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2024.1409608

DOI=10.3389/fped.2024.1409608

ISSN=2296-2360

ABSTRACT=Lower urinary tract dysfunction (LUTD) in Cerebral Palsy (CP) and other neuromuscular diseases can present with chronic retention that leads to hydronephrosis, recurrent Urinary Tract Infections (UTI), and stone formation . Whenever the conservative treatment of LUTD fails for any reason it is considered as complicated LUTD , in which a surgical approach is warranted . Cutaneous Vesicostomy (CV) is a simple, well-tolerated, and potentially reversible that protects the upper tracts. We describe our experience with using CV for this complex population.Children with CP and other neuromuscular diseases admitted to pediatric long-term care units for palliative care. They present multi-system involvement, polypharmacy, and Gross Motor Function Classification System (GMFCS) levels of 4 or 5. We retrospectively studied this population's indications and results of CV between 2015 and 2019.Results: 18 out of the 52 admitted patients presented LUTD with UTI (18 -100%), stones (5 -28%), progressive hydroureteronephrosis (3 -17%) or stones (2 -11%). Conservative initial management (catheterizations, prophylaxis antibiotics) was effective in half. The remaining nine were defined as Complicated LUTD and underwent CV. After a mean follow-up of 11.3 months, follow up showed improved hydronephrosis in all nine patients (100%). Recurrent UTI were no longer seen in 8 of 9, although 3 required bladder irrigations; bladder stones did not recur after CV; the kidney stones needed further intervention. Revision of the CV was required in 2 cases (11%) at 12 and 24 months postoperatively due to stoma stenosis. CV is a relatively simple and effective procedure representing a pragmatic solution for managing Complicated LUTD in complex long-term institutionalized pediatric palliative care patients with neuropathic bladders.CV is a relatively simple and effective procedure representing a pragmatic solution for managing Complicated LUTD in complex long-term institutionalized pediatric palliative care patients with neuropathic bladders.