Poor bladder emptying often requires clean intermittent catheterisation (CIC). In significant numbers of children CIC is not possible for a variety of reasons and an alternative is needed. This paper reviews a single centre’s usage of the vesicostomy button over the course of 13 years. Thirty children (age range four days to sixteen years) had a vesicostomy button placed (either a Mic-Key button, Ballard Medical products, or a Mini balloon button, Applied Medical technology) for a median usage length of 11 months (although seven still had the button in situ at the time of writing the paper, the longest for five and a half years). Indications for use were neuropathic bladder (15), congenital bladder hypotonia (6), functional bladder disorders (5) and post obstructive bladder (4). Buttons remained on free drainage for 48 hours post insertion before starting an intermittent drainage regime. Buttons were changed at six-week intervals, the first being in hospital under specialist nurse supervision with subsequent ones at home by the parents. As experience developed, button changes were extended to every three months. Minor complications in 12 patients included transient leakage, wound infection and over-granulation of skin tissue. Major complications occurred in five patients (two urinary tract infections, one device failure, two significant leaks) requiring revision of the tract or button removal. The benefits of a button over a suprapubic catheter include less risk of fall out, ability to carry on normal routines, and easier to manage by parents. The paper concludes that the vesicostomy button is a useful, relatively minimally invasive device for underactive bladders to facilitate regular emptying.
