Posterior Urethral Valve !

• 25 Apr 2020 02:56:53 PM
• |Pediatic Urology

Q. Why is vesicostomy done in PUV and not just a SPC ? 

Comments(5)

• 

  Dr. Anil Takvani

  25 Apr 2020 05:47:36 PM

  If diversion necessary in patients of PU valve, it is for longer period of time. It may be for months or for couple of years.

  How SPC can hold so long?

  With this I would like to request you to read on PUV chapter...

  Thanks

• 

  Rahul Kapoor

  26 Apr 2020 06:43:20 PM

  Defunctioning of the bladder by making a large opening is needed, therefore larger hole is better. 

  Managing a vesicostomy is easier than a SPC. 

  Decrease chances of UTI, as u avoid the foreign body

• 

  Jaideep Mahajani

  26 Apr 2020 10:13:07 PM

  Secondly by SPC you are increasing bladder spasms. So the purpose of diversion itself gets defeated. 

• 

  Chandra Singh J

  01 May 2020 09:58:12 PM

  Commonest cause for failure of vesicostomy is siting it lower down. As such, the indications of vesicostomy are limited. But when indicated, it should be placed at the dome of the bladder. The key is to track it down from the urachus, instead of going from the anterior surface of the bladder.

  When it is not at the dome of the bladder, the posterior wall collapses and plugs the vesicostomy. Often it is structurally patent but child continues to void per-urethrally and the hydronephrosis worsens. So when indicated, siting it as high as possible, both in terms of skin incision and bladder incision and ensuring the opening is sufficient to admit the little finger, then it will serve the purpose.

  
  

• 

  Ramesh Babu

  02 May 2020 09:46:55 AM

  Primary valve fulguration is the method of choice in all PUV

  
  

  If VUR is seen in a PUV child who is not amenable for primary fulgration - then I would prefer unilateral loop ureterostomy on thr refluxing side over a vesicostomy. This decompresses both systems as the bladder fills and refluxes. 

  
  

  Vesicostomy often makes already conracted bladder further smaller in a PUV kid. Any tube (SPC/nephrostomy does nt stay for long in babies- max 7 days if lucky)