Percutaneous button cystostomy (PBC) has been suggested as a valuable alternative for managing neurogenic bladder-sphincter dysfunction (NBSD) in children and adolescents who cannot tolerate or effectively utilize clean intermittent catheterization (CIC). In these patients PBC allows to avoid major surgery for continent diversion, as Mitrofanoff or Monti procedures - requiring extensive intrabdominal surgeries - offering a higher level of quality of life (QoL) compared to incontinent derivations.
Over time, we modified the original PBC technique described by Subramaniam et al., in order to improve procedural applicability and reduce the frequency of conversions to open surgery. This study evaluates the safety, feasibility, and effectiveness of this modified PBC approach in pediatric and adolescent populations.

We conducted a retrospective analysis of all patients undergoing modified PBC placement between 2020 and 2024. The main technique implementation consists of anchoring at first step the anterior bladder wall to the abdominal wall under endoscopic control to ensure bladder fixation and stability throughout the whole procedure. As second step, after bladder puncture with Seldinger technique, a guidewire is inserted in the bladder and, subsequently, extracted through the urethra. As third step, progressive bladder and abdominal wall dilation, as well as  button insertion, are performed using the established guidewire pathway. Primary outcomes included the rate of conversion to open surgery, occurrence of complications, patient-reported tolerance, and effectiveness in achieving satisfactory bladder management. Descriptive statistics were applied to assess procedural outcomes and complication profiles.

Fifty pediatric patients (32 males) with a median age of 7.9 years (IQR: 4.6–13.3 years) underwent modified PBC placement. Indications included spinal dysraphism (N=36), central neurological impairment (N=7), posterior urethral valves (PUV, N=4), severe bilateral vesicoureteral reflux (VUR, N=2), and epispadias (N=1). Five patients were under the age of one year. The procedure was completed successfully in all cases without intraoperative complications or conversion to open surgery, with a mean operative time of 45 ± 4.3 minutes.
During a mean follow-up period of 22.9 ± 17 months, nine complications were recorded: six cases of non-febrile urinary tract infections, two instances of peristomal leakage, and one device dislocation. Importantly, no complications were reported in patients younger than one year. Overall, 46 out of 50 patients experienced satisfactory device tolerance and effective bladder management, while four patients required alternative management techniques (1 patient progressively accepted to perform self-administered CIC, while 3 patients accepted surgical continent derivation: 2 Mitrofanoff and 1 Monti).

The modified PBC technique demonstrated a favorable safety profile and high efficacy across a broad pediatric population, with no cases of conversion to open surgery or intraoperative complications. The majority of patients (46/50) reported successful bladder management with minimal complications, particularly among those aged under one year. These findings suggest that PBC is a reliable, minimally invasive option for pediatric bladder management across diverse underlying conditions. Furthermore, PBC seems useful to postpone major surgery in children and/or permit patients and caregivers to progressively accept CIC.

The modified PBC technique is effective and feasible for pediatric patients and young adults with various bladder dysfunction and related management needs, demonstrating consistent safety and favorable outcomes regardless of age or underlying pathology. This approach appears especially promising for infants and newborns with conditions such as PUV and severe VUR. Further comparative studies are needed to validate its efficacy and safety in these specific subgroups.