Vesicostomy: The Salvage Procedure for Resource-limited Urology Units; The KCMC Experience in Tanzania

Abstract

Background: Posterior Urethral Valves (PUVs) is the commonest cause of bladder outlet obstruction in male infants and children. Vesicostomy is a temporary procedure to relieve the obstruction and save the kidneys from a progressive failure.
Objectives: The primary objective of this study was to evaluate the benefits of vesicostomy in the initial management of children with posterior urethral valves (PUVs) in urology units with no infant endoscopes. The secondary objectives were to determine the effect of vesicostomy on
improving or resolving hydronephrosis and stabilizing or improving renal function.
Study Design: A retrospective hospital-based study.
Setting: The study was conducted in the department of urology of Kilimanjaro Christian Medical Centre (KCMC), a tertiary hospital located in Moshi, Tanzania.
Methods: Children who underwent vesicostomy between September 1998 and January 2012 were identified from theatre operation books. Patients’ details including age, clinical presentation, serum creatinine, and imaging study (abdominal ultrasound and / or Micturating CystourethroGram) findings at presentation were extracted from the files of patients. The same variables were again documented in line with the objectives of the study with a three month postvesicostomy reference for comparison.
Results: Forty-three patients had vesicostomy done in the period of study. The age ranged from 4 days to 15 months with a median of 6 months and mean ± standard deviation of 9.6 ±13.2months. The number of patients with severe hydronephrosis dropped from 26 (60.5%) to 17 (58.6%) three
months after vesicostomy. This statistically insignificant change remained largely unchanged for the rest of the follow up. There was a significant decrease in serum creatinine three months after vesicostomy with a mean difference of 113.32umol/l (P < 0.001).
Conclusion: The study results showed that vesicostomy is reno-protective. Centres in the developing world without infant endoscopic equipments for primary ablation of valves should be encouraged to perform temporary vesicostomy.

Key words: Posterior urethral valves, vesicostomy, electro- fulguration, renal failure.