Q. Why is vesicostomy done in PUV and not just a SPC ?
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.
Defunctioning of the bladder by making a large opening is needed, therefore larger hole is better.
Secondly by SPC you are increasing bladder spasms. So the purpose of diversion itself gets defeated.
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.
Primary valve fulguration is the method of choice in all PUV