A vesicostomy is a surgically created opening from the lower belly to the urinary bladder. It allows urine to drain, preventing the build-up of pressure within the bladder. Improper emptying of the bladder or increasing pressure within it, unfortunately, is dangerous. These complications can cause frequent urinary tract infections that lead to permanent kidney damage.
A vesicostomy is a temporary measure to stall disease progression while definitive treatment is planned and carried out.
What Is a Vesicostomy?
A vesicostomy is an opening created in the bladder to drain it. It usually opens within the abdomen, below the umbilicus (belly button). It is usually placed between the pubic bone and the umbilicus.
Urine dribbles from this opening constantly. It prevents urine from going back up to the kidneys (reflux), reducing urinary tract infections and kidney damage. Your child will need a diaper to absorb the urine. A vesicostomy provides a temporary solution to urinary retention. You and your child's doctor can then discuss and plan long-term alternative solutions to drain the bladder.
Vesicostomy Children — Why Is It Done?
A vesicostomy is a temporary solution to prevent kidney damage in infants or young children. Incomplete emptying of the bladder can let bacteria grow in it and cause urinary tract infection (UTI). These infections can ascend the ureters and reach the kidneys. Kidney infections (pyelonephritis) can cause scarring of the kidneys, leading to later hypertension (high blood pressure) and kidney failure. Urinary bladder emptying problems can stem from anatomical defects or nervous system disorders.
Neurogenic bladder. A defect in the function of the urinary bladder because of nervous system disorders. The nervous system may be damaged by injury or disease. Your child could have an inability to control urination (incontinence) or to pass urine (retention). A vesicostomy is done in cases of retention.
Spina bifida. This is a condition in which a baby's spine and spinal cord do not develop as they should. Meningocele, myelomeningocele, and spina bifida occulta are types of spine bifida. Affected children may have weakness or paralysis of the legs, inability to control the bowel and bladder, and loss of sensations in the lower half of the body.
Some other conditions where a vesicostomy might be needed are complex urethral strictures, Prune Belly syndrome, and idiopathic dysfunctional bladder.
Passing a catheter through the urethra is a method for relieving urinary retention, but leaving the catheter in place elevates rates of urinary tract infection (UTI).
The other option is clean intermittent catheterization (CIC), in which an aseptic technique is used to insert a catheter into the bladder every few hours. Some boys find it painful, though, and it is often difficult in the case of girls.
This is a surgical procedure and will be performed by a surgeon in an operating room. Your child will be put to sleep (general anesthesia) during surgery, so they will have to stop eating and drinking for four hours before the procedure.
The urinary bladder is approached through a cut made in the abdominal wall. The wall of the bladder is opened and sewn to the abdominal wall. The procedure takes an hour or two, and you may have to spend a night in the hospital.
Your child may have some pain after waking up from anesthesia. Your surgeon will prescribe medicines for pain relief. The vesicostomy is not painful after it has healed.
Diapers should be large enough to cover the vesicostomy opening and ensure that urine doesn't leak. Use absorbent diapers that fit well. Change the diaper frequently to prevent leaks.
Diaper rashes may happen around the skin opening. Take care to keep the area as clean and dry as possible. Your doctor may prescribe a diaper rash cream with zinc oxide.
Caring for a Vesicostomy
Infection is a major risk, and you must be very careful about hygiene. Always wash your hands before changing your child's diapers.
The vesicostomy opening may start to close before its intended purpose is fulfilled. Your doctor may advise you to pass a sterile catheter through it once or twice a day to keep it open. This procedure is called dilating, and you should try to do it at the same time every day.
Careful attention to technique is crucial to avoid infection:
- Wash your hands well with soap and water.
- Use an antiseptic like Betadine® to clean the area around the vesicostomy.
- Clean the skin in circular motions, moving outwards from the opening.
- Apply lubricant prescribed by your doctor to the catheter tip.
- Insert the catheter ½ to 1 inch (1.25 to 2.5 centimeters) into the opening.
- Move the catheter back and forth.
- Remove the catheter.
- Clean the area to remove the antiseptic from the skin.
There may be a little bleeding during or after dilation.
When to Call Your Doctor
You should call your doctor if:
- There is no urine leakage for 2 hours. Constant drainage of urine from the vesicostomy is essential.
- Your child has a high fever
- There is redness or crusting around the vesicostomy.
- You can't pass the catheter through the opening.
- Your child is in pain.
- Urine contains blood.
Bladder prolapse. A part of the bladder is forced out through the vesicostomy when the child strains. Usually, you will be able to push it back after the child has finished straining. If you are unable to replace the prolapsed bladder, you should contact your doctor immediately.
Urinary tract infections. UTIs frequently happen to children with vesicostomies. Bladder pain, fever, chills, and shivering should alert you. Your doctor will ask for laboratory tests to confirm an infection and treat it with antibiotics.
Vesicostomy vs. Mitrofanoff Procedure
The Mitranoff procedure is a surgical procedure for continent urinary diversion (CUD). The surgeon uses the appendix to create a tube from the urinary bladder to the abdominal wall. The child can insert a catheter to empty the bladder at regular intervals.
A vesicostomy requires constant diaper wearing and may be socially unacceptable for older children. The smell of urine also is unpleasant. The Mitranoff procedure allows these children (and adults) to stay dry without diapers. Most can carry out their usual activities and have no problem with self-care.
This is a complex surgery and is not always successful, but it gives a better quality of life than a vesicostomy for older children and adults. CUD procedures are valuable for people needing urinary bladder-emptying support lifelong.