Vesicosto

Overview

A vesicostomy is a surgical procedure that helps a child empty their bladder when they are unable to do so on their own. During the procedure, the surgeon creates a small opening in the child’s abdomen, usually below the belly button, to allow urine to drain. The purpose of a vesicostomy is to prevent urine from backing up into the kidneys and urinary tract, which can lead to Urinary Tract Infections (UTIs) and kidney damage. Instead of using a colostomy bag, the urine drains directly into the child’s diaper.

This procedure is a temporary solution while the healthcare provider addresses the underlying cause of the bladder issue. They will advise on how long the vesicostomy may be necessary. The surgery is performed under general anesthesia in an operating room, and it may require an overnight hospital stay.

Reasons for undergoing the procedure

A vesicostomy assists in draining a child’s bladder when they are unable to do it on their own. If the bladder isn’t emptied, pressure can increase, causing urine to flow back into the kidneys, which may lead to kidney damage. The most common reasons for requiring a vesicostomy include:

• Vesicoureteral reflux (VUR).
• Congenital urological anomalies.
• Bladder outlet obstruction.
• Spina bifida or neurogenic bladder.
• A spinal cord injury or nervous system disorder.
• Recurring UTIs.
• Prune belly syndrome.

There is no specific age at which children undergo a vesicostomy. Generally, most children who undergo this procedure are under five years old, though it can also be performed on older children and teenagers, albeit less frequently.

Risks

With any surgery, there is a small potential of complications. Following a vesicostomy, the following issues could happen to your child:

• Bladder prolapse, which occurs when the bladder protrudes through the opening.
• The vesicostomy opening closing too soon.
• Urinary Tract Infection (UTI).

Before the procedure

Your child’s doctor will provide detailed instructions on how to prepare for the procedure. Be sure to inform them about any medications your child is taking and any known allergies. They will also advise you on when to begin limiting food and drinks, including breast milk or formula, prior to surgery.

During the procedure

The surgeon will take your child to the operating room and insert an IV to deliver medication through a vein. Your child will then receive general anesthesia, ensuring they won’t feel any pain during the procedure.

For the vesicostomy, the surgeon will make a small incision in your child’s lower abdomen, create an opening in the bladder, and position it through the abdomen to allow urine to drain.

After the surgery, the surgeon will instruct you to insert a catheter through the vesicostomy opening a few times a day to keep it from closing too soon. You’ll also be given guidance on how and when to stretch the opening to prevent early closure. A vesicostomy typically requires one to two hours of surgical time.

In order to prepare yourself for what to expect during the procedure, check with your child’s surgeon beforehand.

After the procedure

Many children are able to go home a few hours after recovering in the recovery room, though some may need to stay overnight for monitoring. 

Most children experience only mild discomfort following the procedure, and your child’s doctor will advise you on what pain relief to use. Typically, ibuprofen or acetaminophen is sufficient, and the pain should subside within a few days. Most children can return to daycare or school within about a week, but they should avoid activities that might harm the vesicostomy opening, like wrestling, bike riding, or running.

Your child will need to wear a diaper that fully covers the vesicostomy opening to collect urine. It’s normal for the skin around the opening to become irritated or develop a rash, so keeping the area clean and dry is important to prevent infection. Your doctor will give you instructions on how to care for the site, and you may also use diaper rash cream or ointment. Diaper changes can continue as usual.

If you’re tasked with stretching the opening to keep it from closing, your child’s surgeon will guide you on how long this will be necessary. Eventually, the surgeon will close the vesicostomy.

Outcome

The majority of kids recover greatly from vesicostomies. Some people’s skin irritation might require a little extra diaper rash ointment. To ensure that the entrance is covered appropriately and their clothes don’t get wet, some kids might require a larger diaper. 

In situations where your child is straining, like during a bowel movement, a tiny portion of their bladder may pass through the incision. You can gently press their bladder back in with clean fingertips if it doesn’t go back in after they bear down. If it doesn’t fit back in, give your child’s doctor a call. If the opening begins to close prematurely, the surgeon may need to reopen it. As you extend or enlarge the opening, make sure you follow any guidelines you have to avoid the vesicostomy closing too soon.