Has vesicostomy a role in the neuropathic bladder?

This retrospective study aims to assess the efficacy of vesicostomy in the management of deteriorating upper renal tracts in patients with neuropathic bladders for whom intermittent self catheterization is not a clinical option. Between 1980-1987 vesicostomy was performed in 16 such patients (11 female, 5 male). Eleven had myelomeningocoele, 4 sacral anomalies and one cerebral palsy with scoliosis. All patients had urinary tract infections and deteriorating hydronephrosis and hydroureter (IVP, U/S); associated reflux in 13, impaired GFR in 4 and abnormal biochemistry in 8. The mean age at surgery was 3.3 years (8 mths. to 9 years). In all cases deterioration was arrested by vesicostomy. Fifteen patients showed structural or functional improvement and one stabilized. Late closure of the vesicostomy in two cases resulted in disimprovement of biochemical and radiological parameters. Acceptance of the vesicostomies was good. We advocate vesicostomy as an effective drainage procedure to preserve function in patients with neuropathic bladders and deteriorating renal tracts, in whom intermittent self catheterization is not a realistic alternative.