Long-term bladder and renal outcomes after cutaneous vesicostomy closure in pediatric patients with non-neurogenic bladder

Abstract

Purpose: To assess long-term outcomes of vesicostomy on bladder capacity (BC) and voiding function in non-neurogenic bladder, and explore the association between kidney ultrasonographic findings and renal function. Materials and Methods: Thirty-four patients under 2 years at the time of vesicostomy formation (2005-2020) with >= 3 years of follow-up were reviewed. Patients were further stratified based on neurogenic bladder status. Twenty-one patients were nonneurogenic. A subgroup analysis of 7 patients under 3 months with primary vesicoureteral reflux (VUR) and compromised renal function was conducted. Results: The median age at vesicostomy formation was 1.0 months (interquartile range [IQR] 0.0-3.5); the median duration of vesicostomy was 16.0 months (IQR 8.0-21.0). At a median age of 93.0 months (IQR 59.5-117.5), all patients achieved spontaneous micturition and continence. Eleven patients (52.4%) showed bell-shaped voiding patterns. Five patients showed interrupted (n=2) or plateau (n=3) patterns. With the exemption one patient, all patients with primary VUR showed bell-shaped curves. None initiated clean intermittent catheterization during follow-up. The median BC-to-estimated BC in patients with non-neurogenic bladder and primary VUR was 0.9 (IQR 0.7-1.1) and 0.9 (IQR 0.8-1.1), respectively. Three patients underwent revision due to prolapse. The glomerular filtration rate (GFR) was improved by 68.9% compared to the baseline (p=0.045). Parenchymal abnormalities on kidney ultrasonography were associated with decrease in GFR. Conclusions: Vesicostomy in non-neurogenic bladder patients was associated with recovery of BC, preservation of continence, and improved renal function. Parenchymal abnormalities on ultrasonography predicted lower GFR.