Bladder drainage is necessary for the patients with chronic urinary retention. The first choice for drainage is clean intermittent catheterization, however there are some patients to select indwelling urethral or suprapubic catheterization because of difficulty of intermittent catheterization. These patients often have complications of bladder stone or urinary tract infection. Therefore, frequent replacement of catheters or removal of bladder stones is necessary but its effect for prevention of complications is not permanent. Meanwhile, another bladder drainage option is vesicostomy which is popular for the patients of pediatric population with urinary retention but there is only one study that has been applied to adult patients with voiding dysfunction [1]. In this study, we aim to apply vesicostomy technique to adult patients with urinary retention who developed complications during long-term catheterization.

This retrospective study involved patients who have the status of indwelling a bladder catheter for urinary retention and suffered from bladder stones or urinary tract infection associated with catheter from April 2019 to October 2021. Vesicostomy was performed according to the previously described method adding some modifications [2]. Additional surgeries for stone or infection were performed concurrently if necessary. A colostomy pouch was applied for the stoma. Residual urine was measured with computed tomography seven days after the operation. We followed up all patients over three months to identify the presence of postoperative complications.

Nine patients were included in this study. Eight were male and one was female. Median age at the operation was 65 (range 23-92). Background diseases were neurogenic bladder due to cerebral or spinal infarction in 3, cerebral palsy in 3,spinal cord injury in 1, myelomenigocele in 1, benign prostatic hyperplasia in 1. Coexisting disease were urinary tract stones in 5, cardiac disease in 3, and end-stage liver cancer in 1. Concurrent operations were lithotomy in 5, closure of cystostomy in 1, removal of bladder foreign body in 1 and nephrectomy in 1. Median operative time was 183 (range 111-560) minutes and median blood loss was 409 (range 20-560) ml. Median residual urine volume in bladder was 27 (range 5-51) ml. Perioperative complications were delirium (Clavian-Dindo gradeⅡ) in 2 or stoma bleeding (Clavian-Dindo gradeⅡ) in 1. There was no complication of bladder stone, febrile urinary tract infection or stomal stenosis postoperatively.

Results in this study suggest usefulness and safety of the vesicostomy technique for the adult patients who have the complications of bladder stone or urinary tract infection suffered from indwelling bladder catheters for urinary retention.

Vesicostomy could be one of the bladder drainage options for selected adult patients who are not feasible for treatment with indwelling catheterization.

Tobu S et al. Usefulness of Blocksom vesicostomy in elderly men with chronic urinary retention and severe dementia. Geriatr Gerontol Int 2015;15:997-1000
Blocksom BH Jr. Bladder pouch for prolonged tubeless cystostomy. Trans South Cent Sect Am Orol Assoc 1956;51:1-4.