Bocksome Vesicostomy-By Prof. S S Joshi

• 20 Jun 2020 07:49:16 AM
• |Pediatic Urology

Dear All,

Comments(4)

• 

  Dr. Anil Takvani

  20 Jun 2020 08:11:34 AM

  Also posting possible issues and complications related to vesicostomy procedure.

  Prof. S S Joshi and all of you can write on how to minimize this issues or complications.

  Complications and its percentage taken from article of Skoog at al. J. Urol

  Thanks

  

• 

  Dr. Anil Takvani

  21 Jun 2020 11:57:33 AM

  On behalf of Prof. S S Joshi Sir,  I am posting schematic images of Blocksome vesicostomy technique...thanks 

  

• 

  shriram joshi

  21 Jun 2020 12:28:53 PM

  This is simple operation, you follow the steps correctly and isolate the urachus. Incision is about 1" long from one rectus to other. Separate the rectii in. Midline. Identify the uraçhus cut a little way from fundus. Mobilse fundus minimally to bring the urachal attachment with fundus in the wound. Fix the wall of bladder to rectus sheath, as shown in the figure.

  Open the fundus wide enough to suture to skin edges, all layers.

  SSJ

• 

  Venugopal P

  22 Jun 2020 10:03:59 AM

  Dear All,

  After Shyam’s comment on ‘Blocksom Vesicostomy’, there is little one can add except historically.

  The concept of a Suprapubic Diversion emanated with Roger Barnes et al (1953) creating a Suprapubic Diversion of Bladder using a Bladder Flap Protruding out of the skin in the form of a ‘spigot’ which could be clamped with a Cunningham’s clamp and released intermittently to empty the bladder. The main problem was retraction of spigot and this posed difficulty in bladder emptying.

  Blocksom (1957) introduced his technique and what he called as ‘Tubeless Cystostomy’. This was modified by Rinker, Caffery and Witherington (1959) and assumed the current technique. It was Duckett et al (1960) popularized this technique for PUV as a diversion instead of Per Urethral drainage for those patients having Outlet obstruction.

  Lapides, J., Ajemian, E. P. and Lichtwardt (1960) described their technique of ‘Tubeless Cystostomy’ by raising both a bladder flap and a skin flap. This procedure was introduced for children with Myelomeningocoele but was adapted for PUV also by some workers.

  I have done both Blocksom and Lapides procedures. For PUV, the procedure of such diversion is needed only till the child stabilizes and is ready for valve fulguration when fit and availability of suitable endoscope. Closing of Vesicostomy when needed is easier with Blocksom than with Lapides.

  I would also like to direct attention to ‘Button Vesicostomy’. There are articles advocating this procedure for Bladder Outlet Obstructions. I am providing a link for an article with 13 yeas experience with this procedure.

  https://www.jpurol.com/article/S1477-5131(13)00165-4/pdf

  With warm Regards,

  Venu