Vesicostomy

Introduction

A vesicostomy is a procedure carried out on infants and toddlers whose bladders do not empty properly, and who cannot be managed with regular, clean intermittent cathertirisation.

A vesicostomy is often carried out on children who have been diagnosed with posterior urethral valves, spina bifida and other genito-rectal complications.

The main purpose of the procedure is to prevent urinary tract infections and prevent urine from going back into the kidneys and causing damage.

A vesicostomy is performed in an operating room under a general anaesthetic. An opening is created in the child’s abdomen, just below their belly button, and looks like a small slit surrounded by reddish-pink tissue. The opening allows urine to continuously drain as a direct channel between the bladder and abdominal wall so it doesn’t get trapped inside the bladder and cause infection or further damage.

After surgery, your child:

• may need to stay in hospital overnight
• may have an IV line/drip for fluid replacement and pain management. This will be removed as soon as your child is drinking well, and tolerating oral medication
• may have blood-stained urine draining from the new opening in the first few days’ post-surgery. This is normal and usually settles as soon as your child is drinking normally
• may have a small amount of bleeding at the site of the incision
• may have a catheter in the new opening
• may have urine draining from the opening, directly into a nappy or continence brief. If the vesicostomy is still needed when your child is older, a urine collection system/bag may be used to contain the urine and keep the child’s clothing dry

Your doctor will instruct you on any specific vesicostomy management. Once you are home, your child can have a bath or shower as usual. After ten days, they can also go swimming in a pool or the ocean.

The new opening on your child’s belly sometimes needs to be stretched each day to ensure it stays open enough for urine to drain out. Stretching is done with a catheter. If your child needs this, you will be taught how to do it and how often it needs to be performed.

You will need to pay special attention to your child’s skin post-surgery. Nappies/continence briefs should be checked regularly and changed when wet to prevent skin irritation. If this happens, change the nappy more frequently and keep the skin protected with barrier cream. Your doctor may also advise a medication or ointment for your child.

Call your doctor if:

• urine does not drain from the vesicostomy for more than two hours
• urine coming from the vesicostomy changes in smell or looks unusual
• there is blood in the urine
• your child develops a high temperature (more than 38.5°C)
• the skin around the opening looks red or irritated, or bulges out more than usual
• you are unable to pass the catheter
• your child experiences pain.