Vesicostomy

What is a vesicostomy?

A vesicostomy is a procedure to allow pee (urine) to drain from a child’s bladder when they have trouble emptying their bladder on their own.

It involves a surgeon making a small opening in a child’s abdomen (usually just below their belly button). The goal of a vesicostomy is to prevent pee from backing up into a child’s kidneys and urinary tract, where it can cause urinary tract infections (UTIs) and kidney damage. The pee drains directly into your child’s diaper instead of draining into a colostomy bag.

The procedure is a temporary fix while your child’s healthcare provider determines how to treat the underlying reason your child can’t empty their bladder. They can let you know how long your child may need to pee in this way.

Your child’s surgeon performs a vesicostomy in an operating room while they’re asleep (under general anesthesia). It may involve spending one night in the hospital.

Why would a child need a vesicostomy?

A vesicostomy helps to empty a child’s bladder when they’re unable to do so on their own. When a person can’t empty their bladder, pressure builds up and pee can reflux back to their kidneys, damaging them. The most common reasons for needing a vesicostomy are having:

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

What age do children get vesicostomy at?

There’s no set age. However, most children who get a vesicostomy are younger than 5 years old. Older children and teenagers having a vesicostomy is rare, but it does happen.

How do I prepare my child for a vesicostomy?

Your child’s healthcare provider will give you instructions on how to prepare. Let them know about any medication your child takes and if your child has any allergies you know of. They’ll let you know when to start restricting food and beverages (including breast milk or formula) before surgery.

What happens during a vesicostomy?

Your child’s surgeon will take them back to the operating room and insert an IV. The IV delivers medication to your child through a vein. Then, your child receives general anesthesia, which prevents them from feeling any pain.

A vesicostomy involves a surgeon making a small incision in your child’s lower abdomen. They’ll make an opening in your child’s bladder and position it through their abdomen. This opening allows pee to drain from their bladder.

Your child’s surgeon will ask that you place a catheter through the vesicostomy opening a few times a day so that the opening doesn’t close too soon. You’ll receive instructions on how and when to stretch the opening to prevent it from closing.

How long does vesicostomy take?

It takes about one to two hours for a surgeon to perform a vesicostomy. Check with your child’s surgeon before the procedure so you know what to expect while you wait.

Is a vesicostomy painful?

Your child shouldn’t feel any pain during a vesicostomy. They may have some discomfort afterward when the anesthesia wears off. Over-the-counter (OTC) medication like ibuprofen (Motrin®) or acetaminophen (Tylenol®) can relieve their pain, but sometimes, prescription medication is necessary.

What happens after a vesicostomy?

Many children can go home several hours later after they recover in the recovery room. But in some cases, a child will need to spend the night in the hospital for monitoring.

Most children have only a small amount of pain afterward. Your child’s provider will let you know what you can give your child to help with pain. In most cases, ibuprofen or acetaminophen offer enough relief. This pain should completely subside within a few days. Most children can resume going to daycare or school within about a week. Don’t allow your child to do anything that could damage the opening, such as wrestling or roughhousing, riding bikes or running.

Your child will need to wear a diaper large enough to cover the vesicostomy opening and hold their pee. It’s common for rashes and irritation to occur at the skin opening. Try to keep that area dry and clean to prevent infection. Your child’s provider will give you instructions on how to care for the opening. Using diaper rash cream or ointment is also an option. You’ll change your child’s diaper as you normally do.

If you’re stretching the opening to help it stay open, your child’s surgeon will tell you how long you need to do this. Eventually, your child’s surgeon will close the opening.

What does a vesicostomy opening look like?

The opening looks like a small cut surrounded by tissue that’s light pink.

Is a vesicostomy permanent?

No, it’s temporary. Healthcare providers typically do a vesicostomy while they figure out long-term treatment.

What are the benefits of a vesicostomy?

A vesicostomy is a necessary procedure because it drains pee from your child’s body. If pee backs up from their bladder into their kidneys and urinary tract, it can cause UTIs. If the infection reaches your child’s kidneys, it can cause:

• Kidney infection.
• Kidney scarring.
• Renal hypertension.
• Kidney failure.

Your child’s provider may determine this is the best procedure to remove pee from your child’s body and avoid the potentially damaging effects of pee building up.

What are the risks of a vesicostomy?

All procedures carry a small chance of complications. Your child is at risk for the following complications after a vesicostomy:

• Urinary tract infection (UTI).
• Bladder prolapse (when their bladder comes through the opening).
• Closing of the vesicostomy opening too soon.

What is the outlook for a child who has had a vesicostomy?

Most children do very well after a vesicostomy. Some may need a little extra diaper rash ointment due to skin irritation. Some children may need a larger diaper to make sure the opening is covered properly and their clothes don’t get wet.

A small part of your child’s bladder may come through the opening when they’re straining, such as during a bowel movement. If their bladder doesn’t go back in after they bear down, you can push it back in gently with clean fingers. Call your child’s healthcare provider if it doesn’t go back in.

If the opening starts to close before it’s supposed to, the surgeon may need to open it up again. To prevent the vesicostomy from closing prematurely, be sure to follow any instructions you have for stretching or widening the opening.

When should I contact my child’s healthcare provider?

A vesicostomy doesn’t typically cause any complications. Contact your child’s healthcare provider if they’re recovering from the procedure and show any signs of infection. These could include:

• High fever.
• Redness and irritation around the incision area.
• Not being able to insert a catheter through the opening.
• Pain and discomfort that’s not getting better with medication.
• Their pee contains blood.

A note from Cleveland Clinic

Hearing your child needs any type of procedure can feel extremely scary. Rest assured that a vesicostomy is a safe and effective procedure that removes pee from their bladder so it doesn’t back up into their kidneys and cause damage. Talk to your child’s surgeon so you understand the procedure and how you can help care for them afterward. Caring for a child after this procedure involves keeping the area clean and dry and inserting a catheter to stretch the opening so it continues to allow pee to empty.