P6.9 A single center experience with MicKey button vesicostomy in pediatric kidney transplant recipients
Saturday March 25, 2023 from 18:00 to 19:15
Zilker 1-2

Brittney Grabowski, United States

Pediatric Nurse Practitioner

Kidney Transplant

Children's Healthcare of Atlanta


A single center experience with MicKey button vesicostomy in pediatric kidney transplant recipients

Brittney Grabowski1, Meredith Combs1, Rouba Garro1,3, Edwin Smith2, Jackson Londeree1,3, Roshan George1,3, Ricardo Arceo Olaiz2.

1Nephrology- Kidney Transplant, Children's Healthcare of Atlanta, Atlanta, GA, United States; 2Urology, Children's Healthcare of Atlanta, Atlanta, GA, United States; 3Nephrology, Emory University, Atlanta, GA, United States

Introduction: Obstructive uropathy is a common cause of end-stage renal disease in pediatric kidney transplant (KT) recipients. Management of ongoing bladder dysfunction post-transplant can be a challenge with potential effects on long-term graft outcomes. We evaluate the course and outcomes of MicKey button vesicostomy at a high-volume pediatric transplant hospital as a temporary measure for bladder drainage post-transplant (Bartsch et al., 2002)
Methods: We performed a retrospective chart review of 200 active pediatric (≤ 21 years of age) KT recipients at our center. We identified nine patients with a MicKey button vesicostomy. Four out of nine (44%) had an existing MicKey button vesicostomy at time of transplant. Five out of nine (56 %) patients underwent MicKey button vesicostomy placement posttransplant. The median time to MicKey placement post KT was 30 months.
Results: Recurrent urinary tract infection (UTI) was common among all patients who underwent MicKey button vesicostomy placement. Two patients remain with Mickey button vesicostomy in place, and two were successfully removed after a duration of 1 month to 3.5 years. Five out of nine (56 %) patients underwent further urological diversion surgeries. Of these five patients, Mitrofanoff was created in three and the remaining two were converted to cutaneous vesicostomy. Recurrent UTI was the most common reason for removal of MicKey button vesicostomy and conversion to alternative bladder diversion.  
Conclusions: MicKey button placement as a means for temporary urinary diversion in pediatric KT patients has the potential for UTI development post-transplant. The future state of this project will involve evaluating the effect of MicKey button vesicostomy on graft function over time and comparing outcomes to a convenience sample of pediatric KT patients who underwent alternative means of urinary diversion. 


[1] Limited surgical interventions in children with posterior urethral valves can lead to better outcomes following renal transplantation. Pediatric transplantation. 2002; 6(5), 400–405. https://doi.org/10.1034/j.1399-3046.2002.02025.x

Lectures by Brittney Grabowski

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