# Blocksom-Type Cutaneous Vesicostomy in Adult Patients With Severe Motor and Intellectual Disabilities: A Retrospective Case Series

## TL;DR

This study explores the effectiveness of a catheter-free urinary management procedure in adults with severe disabilities who face complications from traditional catheter use.

## Contribution

The study provides evidence that Blocksom-type cutaneous vesicostomy is a feasible alternative for managing urinary issues in this specific patient group.

## Key findings

- All patients achieved continuous low-pressure urinary drainage without catheters after the procedure.
- No recurrence of febrile UTIs was observed during follow-up.
- Caregiver burden and living environment challenges were reduced post-surgery.

## Abstract

Background: Urinary tract management in adult patients with severe motor and intellectual disabilities is often challenging because long-term catheter-based management is associated with recurrent urinary tract infections (UTIs), urinary stone formation, catheter-related complications, and increased caregiver burden. Evidence regarding catheter-free urinary management strategies in this population remains limited.

Methods: We retrospectively reviewed six adult patients with severe motor and intellectual disabilities who underwent Blocksom-type cutaneous vesicostomy after failure of conventional urinary management, including indwelling urethral catheters, suprapubic cystostomy catheters, or assisted catheterization. Clinical backgrounds, indications for surgery, postoperative courses, and outcomes were evaluated.

Results: All patients had underlying neurogenic bladder and had experienced recurrent UTIs, urinary stone formation, or difficulty in catheter management prior to surgery. After cutaneous vesicostomy, continuous low-pressure urinary drainage was achieved without the need for indwelling catheters. During postoperative follow-up, no recurrence of febrile UTIs was observed, and urinary tract management stabilized in all cases. In addition, simplification of urinary care contributed to a reduction in caregiver burden and improved living environments.

Conclusions: Blocksom-type cutaneous vesicostomy may be a feasible and effective catheter-free urinary management option for selected adult patients with severe motor and intellectual disabilities who experience refractory complications with conventional catheter-based management. Careful patient selection and shared decision-making are essential when considering this procedure.