Abstract
Children with neurogenic bladder, particularly due to spina bifida, are at high risk of elevated intravesical pressures, vesicoureteral reflux, and progressive upper urinary tract deterioration, which can lead to chronic kidney disease. Vesicostomy is a long-established surgical diversion aimed at providing low-pressure urinary drainage, but its renoprotective effectiveness and patient selection criteria remain inadequately characterized. We conducted a comprehensive review following PRISMA 2020 guidelines. Five databases were searched from inception to July 1, 2025. Studies were included if they involved children (0–18 years) with neurogenic bladder who underwent vesicostomy and reported renal or upper urinary tract outcomes. Methodological quality was assessed using Joanna Briggs Institute checklists. Due to clinical and methodological heterogeneity, data were synthesized narratively rather than via meta-analysis. Seventeen studies met inclusion criteria. Evidence was predominantly from retrospective, uncontrolled case series. In neurogenic-specific cohorts, vesicostomy was associated with stabilization of renal function (e.g., minimal change in serum creatinine) and significant improvement in upper tract morphology, particularly resolution of hydronephrosis. Mixed-etiology cohorts (including obstructive uropathies) reported larger numerical improvements in renal function, though neurogenic-specific effects could not be isolated. Factors associated with better outcomes included early intervention before advanced nephropathy, less severe baseline hydronephrosis, hostile high-pressure bladder dynamics, and a technically adequate, patent stoma. Vesicostomy appears to provide meaningful renoprotection in children with neurogenic bladder, primarily by stabilizing renal function and decompressing the upper urinary tract when performed early in patients with high-pressure bladders and salvageable renal reserve. However, the evidence is limited by retrospective designs, small sample sizes, and lack of controlled comparators. Future prospective, etiology-stratified studies with standardized outcome measures are needed to refine patient selection and compare vesicostomy with alternative management strategies.