The Hidden Vesicostomy

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Abstract
A continent vesicostomy has been developed by the use of a tubed bladder flap brought to the skin superficial to the pubic bone and with the stoma sited in the labio-clitoral fold, usually on the right, in right-handed patients. This technique has found application, initially in cases of vesicovaginal fistula, where the continence mechanism has been completely destroyed, and later has been applied to cases of neurogenic bladder due to meningomyelocoele. This operation has been performed on 20 patients. With the exception of our first patient, a technical failure, all patients have been fully continent, the majority on intermittent self-catheterisation. The situation of the stoma facilitates self-catheterisation and the stoma is not visible unless the thighs are abducted and the labia deliberately separated. In patients with a small bladder capacity, augmentation cystoplasty has been done. In males the stoma cannot be so well hidden, although it is not very obvious at the root of the penis in the pubic hair. This operation offers full continence of urine on intermittent catheterisation and the hope of an acceptable body image.

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