OBJECTIVE To identify and describe the characteristics of a group of patients at our institution who are satisfied with cutaneous vesicostomy for long-term bladder management and never undergo subsequent continence surgery.METHODS Using an IRB-approved registry of our patients undergoing reconstructive urinary tract surgery since 1985, we identified patients who underwent vesicostomy creation and were 15 years or older as of October 2017 and performed a retrospective chart review.RESULTS Sixty-seven patients were included with the most common diagnosis being spina bifida and the average duration of vesicostomy 14.3 years (range 8 months to 35 years). In follow-up, 38 patients (56.7%) had conversations regarding further surgery and 31 (46.3%) had their vesicostomies taken down. Of the 36 patients who still had their vesicostomy at last follow-up, 29 (80.6%) had spina bifida and 14 (38.9%) were satisfied, 1 (2.8%) was unhappy, 4 (11.1%) were deceased and satisfaction was unknown for 17 (47.2 %).CONCLUSION Although often intended to be temporary, in our experience many patients keep their vesicostomy for a long time and into adulthood, with generally high satisfaction and low complications. In the properly selected patient, vesicostomy may be a good long-term operation to prevent infection and renal deterioration, though more rigorous studies of these patients are needed. UROLOGY 144: 255-260, 2020. (c) 2020 Elsevier Inc.