Suprapubic cystostomy and vesicocutaneostomy

Suprapubic cystostomy and vesicocutaneostomy continue to be used frequently as temporary vesical diversion in pediatric patients who develop urethral obstruction (posterior urethral valves, cloacal anomalies, urethral trauma), recurrent urinary tract infection with severe vesicoureteral reflux, or neurogenic bladder associated with spina bifida not responsive to clean intermittent catheterization. Vesicocutaneostomy is more appropriate for long-term usage because of no catheter. Suprapubic cystostomy is usually inserted into the bladder using Seldinger method in young children. Blocksom's method is easier and has been widely used in vesicocuta- neostomy. It is important to evaluate bladder capacity and superior border of full bladder for adequate stoma marking and not to place the stoma in a position which is too large and too low to prevent bladder prolapse. The decision to close a vesicocutaneostomy should be made only once the bladder function has been assessed and permanent therapy has been planned.