Introduction

A vesicostomy is an opening made in your child’s abdomen that drains urine out of the bladder and into a nappy or bag.
This procedure is done when babies and children cannot drain their bladder properly, on their own, or with a long tube called a catheter. 

The bladder is part of the urinary system. The urinary system includes:

• the kidneys – the organs that filter waste from the blood, turning it into urine or wee
• the bladder – where urine is stored
• the urethra or urinary tract – the tube that takes urine out of the body.

The bladder can overfill and stretch out when it cannot drain properly. This causes urine to go back into the kidneys and, in some cases, the urethra. This can cause severe infection and damage to the urinary tract and kidneys.

A vesicostomy is usually needed in children who have conditions that affect the urinary system and reproductive organs like the penis and vagina. 

This can include:

• posterior urethral valves – a condition where body tissue grows inside the urethra, blocking urine from leaving the bladder
• neurogenic bladder – when the bladder cannot send or receive signals from the brain and spinal cord properly
• spina bifida – a condition that affects how the spinal cord develops and works.

The hospital will give you information on preparing your child for the procedure. 

• This will include information like:
• when to stop eating and drinking
• what time to arrive
• how long your child will stay in hospital
• what to bring with you.

Make sure you ask your child's treatment team any questions you may have about the procedure and recovery.

Let the hospital know as soon as possible if your child shows signs of illness like fever or breathing difficulties. 

Surgery may need to be rescheduled if your child is unwell.

The operation is done under a general anaesthetic. This means your child will be asleep during the surgery.

Generally, the steps of the vesicostomy procedure are

1. the surgeon makes a small cut into the abdomen, just below the bellybutton
2. through the cut, an opening is made from the bladder to the outside of the abdomen
3. a small part of the bladder wall is attached to the skin on the lower belly.

The vesicostomy opening will look like a small slit surrounded by reddish-pink tissue. Urine will drain out of the bladder, through the opening and out of the body.

Your child may need a catheter inserted to help keep it open. A catheter is a long, flexible tube that helps urine drain out of the bladder.
 

Your child may stay overnight in the hospital after the procedure. They will be given fluids and medication to manage any pain while they recover. 

It is normal to have some light bleeding around the opening of the vesicostomy and in your child’s urine. This should get better after a few days.

After the procedure, your child will need to wear nappies or continence products to collect the urine. Older children may also use a urine collection system or bag. Continence products are pads and underwear that keep clothing clean and dry.

You will be given instructions on how to clean and care for your child’s vesicostomy before you go home from the hospital.

Check your child regularly for signs of infection or issues with their vesicostomy.

See your local doctor as soon as possible if your child:

• has not drained any urine for more than two hours
• has urine that looks or smells unusual, including a dark colour or signs of blood
• develops a fever
• has redness, irritation, or unusual swelling around the vesicostomy
• has pain that is unusual and ongoing.