Vesico-cutaneous fistula: A modified technique for intermittent catheterization in children with impaired bladder function.

Background: Clean intermittent catheterization (CIC) is fundamental in managing children with impaired bladder function. However, it is not always feasible via the native urethra predominately males with intact sensation.

Aim: In the current study, the experience regarding a modified vesico-cutaneous fistula (VCF) technique for CIC in children is reported.

Patients And Methods: From January 2018 to January 2020, the modified VCF was performed to cases with impaired bladder function for CIC. Before surgery, patients were evaluated thoroughly. The anteroposterior diameter (APD) of the renal pelvis was considered as an indicator of the degree of affection of the upper urinary tract. Postoperative attacks of UTIs, leakage from the fistula, fistula stenosis, and the need for revision were recorded. The technique was accomplished relying on the principles of open Stamm gastrostomy (Fig. 1).

Results: Eight cases underwent a modified VCF due to different pathologies. Their ages, at time of the surgery, ranged from 1 month to 14/ years. The median postoperative follow up period was 12 months. A leakage between catheterizations was experienced in 1 case. Stenosis of the fistula occurred in 1 case and it required surgical revision. No symptoms or signs of urinary tract infection were encountered. The mean APD of the renal pelvis was reduced from 29.8 mm (SD: ±14.6 mm), in the preoperative evaluation, to 17.6 mm (SD: ±10.85 mm) in the postoperative follow up.

Discussion: Vesico-cutaneous fistula is a new technique that provides easy and direct way for CIC. In the current study, a modified VCF technique was introduced to the enrolled patients as a simple maneuver, to make easy self-catheterization. Despite the limitations of this study due to the lack of a control group, the small number of cases, and the short follow up period, this modified technique was able to create a short and straightforward channel to access the bladder for intermittent catheterization. It could be done in redo cases. Results showed an acceptable degree of continence and low rate of complications. Moreover, it was socially accepted among our patients.

Conclusion: Intermittent catheterization in children, with abnormal bladder function, can be done easily and efficiently via a modified VCF.