Is Temporary Incontinent Vesicostomy Associated With Fewer Early Urinary Outflow–Related Complications After Pediatric Ileocystoplasty?

ABSTRACT Aims Pediatric augmentation ileocystoplasty carries a risk of urinary outflow–related complications (ORC), including anastomotic leakage, obstruction of the catheterizable stoma, and febrile urinary tract infection. We evaluated whether temporary incontinent vesicostomy (TIV) reduces early ORC and emergency readmissions, and whether it affects 24‐month function. Methods We retrospectively analyzed 168 children who underwent perimesenteric ileal augmentation with a catheterizable continent stoma between 2000 and 2023: TIV ( n = 133) versus no TIV ( n = 35). The primary endpoint was ORC within 6 months. Secondary endpoints were all‐cause emergency readmissions within 180 days and 24‐month daytime continence, augmented bladder capacity and compliance. Results ORC were less frequent with TIV than without (2.3% [3/133] vs. 28.6% [10/35]; p < 0.001), driven by lower rates of anastomotic leakage (1.5% vs. 11.4%; p = 0.018), urgent obstruction of the catheterizable channel (0% vs. 11.4%; p = 0.002) and febrile urinary tract infection/pyelonephritis (0.8% vs. 8.6%; p = 0.029). At 24 months, daytime continence, augmented bladder capacity (424 ± 113 vs. 406 ± 144 mL; p = 0.402) and compliance (31.4 ± 7.5 vs. 28.1 ± 9.6 mL/cm H 2 O; p = 0.069) did not differ between groups, whereas all‐cause emergency readmissions within 180 days were markedly lower with TIV (3.0% [4/133] vs. 22.9% [8/35]; p < 0.001). Conclusions TIV is associated with markedly fewer early urinary ORC and 180‐day emergency readmissions after pediatric perimesenteric ileocystoplasty, without compromising 24‐month continence or reservoir dynamics. Temporary abdominal urinary drainage and the need for planned TIV closure should be discussed during patient selection and family counseling. The benefit appears most relevant after bladder neck closure and in children at risk for delayed access to specialist care; prospective studies should define optimal patient selection, closure timing and long‐term upper‐tract and channel outcomes.