Vesicostomy for neurogenic bladder with spina bifida: followup.

Of 260 patients being actively followed in a myelodysplasia clinic 48 have had a vesicostomy. Vesicostomy was done because of hydroureteronephrosis in 44 cases, infection in 3 and failure of clean intermittent catheterization in 1. Of the 48 patients 16 underwent closure of the vesicostomy, generally between ages 6 and 10 years, an age when the child is prepared to begin clean intermittent catheterization and is motivated to achieve continence. Two children underwent early vesicostomy closure because the bladder emptied adequately and neither has yet begun clean intermittent catheterization. Two children on clean intermittent catheterization are not acceptably continent. The remaining 12 patients are continent for at least 4 hours on clean intermittent catheterization, some with adjuvant drug therapy. No child has exhibited loss of bladder volume while diverted. Vesicostomy offers excellent temporary decompression of the urinary tract in children with spina bifida and neurogenic bladder, and has no long-term harmful effects on the bladder.