A vesicostomy is a surgical procedure that creates an opening, called a stoma, in the lower abdominal wall directly into the bladder. This opening allows urine to drain continuously from the bladder to the outside of the body. It is primarily performed to relieve pressure within the bladder and ensure proper urine drainage.
Understanding a Vesicostomy
The stoma created by a vesicostomy provides a low-pressure pathway for urine to drain. This continuous drainage helps prevent urine from backing up into the kidneys.
The procedure is most commonly performed in infants and young children, often as a temporary measure. It allows the bladder to decompress and protects the upper urinary tract from high pressures or recurrent infections. Urine typically drains into a diaper or absorbent pad. The goal is to manage urinary flow until a child is older or underlying conditions can be addressed with a more definitive treatment.
Why a Vesicostomy is Performed
A vesicostomy is performed when a child experiences conditions that prevent normal bladder emptying or result in high bladder pressures. These conditions can lead to urine backing up into the kidneys, causing damage or infections. One such condition is neurogenic bladder, where nerve damage affects bladder control, often seen in children with spina bifida. In these cases, the bladder may not empty completely or may generate high pressures that threaten kidney function.
Posterior urethral valves (PUV) are a common reason for a vesicostomy. This condition involves abnormal tissue folds in the urethra that obstruct urine flow from the bladder. A vesicostomy provides immediate relief from this obstruction, allowing the bladder to drain and protecting the kidneys from damage caused by back pressure. Severe vesicoureteral reflux, where urine flows backward from the bladder into the ureters and kidneys, can also necessitate a vesicostomy to reduce bladder pressure and prevent kidney injury.
The Surgical Procedure
The creation of a vesicostomy is a surgical procedure performed under general anesthesia. The surgeon makes a small incision in the child’s lower abdomen, typically just below the belly button. Through this incision, a portion of the bladder is brought to the surface of the abdominal wall.
An opening is then created in the bladder. The edges of this bladder opening are stitched directly to the skin of the abdomen, forming the stoma. A small tube or catheter may be placed temporarily in the stoma to aid healing and keep it open in the days after surgery. Most children typically remain in the hospital for one to two days following the procedure.
Living with a Vesicostomy and Beyond
Caring for a child with a vesicostomy involves daily routines to maintain hygiene and monitor the stoma. Urine drains from the opening, so children wear diapers or absorbent pads to collect it. Regular diaper changes and cleaning around the stoma are important to prevent skin irritation and infection. Applying a skin barrier cream, such as petroleum jelly or Aquaphor, can protect the surrounding skin from moisture.
Parents are taught how to dilate, or stretch, the vesicostomy opening one to two times daily using a small catheter. This helps prevent the stoma from narrowing, ensuring continuous drainage. Potential issues to watch for include:
- Irritation
- Redness
- Poor drainage
- Tissue protruding from the stoma
If urine stops draining for an extended period or the stoma appears infected, medical attention is necessary.
A vesicostomy is often a temporary solution, typically maintained until a child grows older or their underlying urinary condition can be definitively treated. The duration a child might have a vesicostomy varies, but it can range from months to a few years, particularly in infancy. When the time is appropriate, a reversal surgery is performed to close the stoma and allow urine to flow again through the natural urinary tract. This transition marks a return to typical bladder function, often after the primary condition has been resolved or better managed.