The Gastrostomy Button as a Catheterizable Urinary Stoma: A Pilot Study

ABSTRACT 

Purpose

We assessed the impact of the gastrostomy button used as a catheterizable urinary stoma on the infection, encrustation and erosion rates, and quality of life in a series of 19 patients.

Materials and Methods

Patients were selected as candidates for the button based on multichannel urodynamic studies that confirmed an areflexic neurogenic bladder. At study enrollment each patient completed a quality of life questionnaire based on a visual analog scale. If the patient had a preexisting indwelling suprapubic tube, it was replaced with a button. If no preexisting suprapubic tube was present, one was inserted. The button was then inserted approximately 1 month later after an adequate tract was established. For 1 year the patient underwent cystoscopy with urine culture every 2 months for a total of 6 times. Symptomatic infections were treated but asymptomatic colonization was not. A quality of life questionnaire was completed at each visit.

Results

Of the 19 patients 10 had failure, necessitating button removal. These failures were due to an excessive suprapubic distance from skin to bladder, which prevented adequate button fit. All patients in whom the button remained showed significant improvements in quality of life. The colonization rate was 100% but the rate of symptomatic infections was low. The incidence of bladder stones was zero and the rate of encrustation was low.

Conclusions

When used as a catheterizable stoma to treat areflexic neurogenic bladder, a gastrostomy button is a safe, effective option for these patients. The rate of symptomatic infections is low, the risk of bladder stone formation is minimal and erosion was not observed in properly sized button insertions. The current limiting factor is the length of the button compared with the patient suprapubic measurement (length from skin to bladder). Each patient reported that quality of life with the button was significantly better than prior to button placement.

Key Words:  bladder , neurogenic , prostheses and implants , stomas , urinary catheterization , gastrostomy