Button Cistostomy in pediatric population: a simplified mini-inivasive insertion technique.

Pediatric patients with functional or anatomical lower urinary tract obstruction, including neurogenic bladder, require effective bladder drainage to maintain low intravesical pressures, prevent infections, and preserve renal function. Clean intermittent catheterization (CIC) is the standard approach, but it is not always feasible due to patient- or anatomy-related factors. In these cases, continent or non-continent urinary diversion techniques are considered. Among non-continent options, vesicostomy has traditionally been used but is associated with significant morbidity and long-term complications. The cystostomy button (CB), originally developed for enteral feeding, has emerged as a minimally invasive, catheterizable alternative for bladder drainage. Current evidence and clinical experience suggest that CB placement is well tolerated by patients and caregivers, easy to manage, and effective in maintaining reliable bladder emptying without compromising detrusor function. Furthermore, endoscopic placement techniques enhance procedural safety while reducing invasiveness. This study aims to describe our personal modified endoscopic technique used for CB placement, when CIC is not feasible.