A vesicostomy is a procedure in which a small opening is made in the lower abdomen (usually just below the belly button) to allow urine to drain out from a child’s bladder. This usually is done when an infant or young child has problems emptying his or her bladder. A doctor does the procedure in an effort to stop the kidneys from being damaged by the urine flowing back to the kidneys (refluxing).
This is usually a temporary and reversible measure that is done to protect the kidneys until the underyling cause of the problem is corrected. The urine usually just drains into the child’s diaper after a vesicostomy rather than being collected in a bag.
What would cause a child to need a vesicostomy?
Vesicostomy is usually needed to continuously empty the bladder. One cause of this is spina bifida. Another possible cause is spinal cord injury. When a person cannot empty his or her bladder, pressure builds up and the urine can reflux back to the kidneys, damaging them. A temporary vesicostomy is used when a catheter is not enough to stop kidney damage.
Pre-OP for vesicostomy?
During your preoperative appointment, your surgeon may order a chest X-ray, an electrocardiogram or EKG, and blood and urine tests. These are often necessary to determine your body’s overall health status, as well as your stability for surgery and anesthesia.
Vesicostomy procedures are performed in an operating room and are normally completed on an outpatient basis, and do not require an overnight stay in the hospital. (A child will usually stay in hospital for two or three days after surgery).
An opening is made directly into the bladder and sutured to the abdominal wall. This is usually created for children with neurogenic bladders in myelomenigocoele or spina bifida.
Postoperative pouching may be a problem because the stoma is usually level and not protruding from the skin.
Alternative management choices are:
- the use of skin barriers to protect the skin from the urine or
- the use of absorbent pads and changing them regularly
Post-OP for vesicostomy
- Diet: Patients only consume clear liquids immediately after surgery and then progress to a regular diet as tolerated. The anesthesia can cause some stomach discomfort and nausea.
- Pain management: Patients may be sent home with Tylenol #3 to be taken as needed for pain. Most children need it for one to three days. If the doctor prescribed Tylenol #3 (with codeine) tablet or elixir, please try to give it to the patient as little as possible because codeine can cause constipation, which can be painful.
- Incision care: The child may be placed in the bath or swimming pool 24 hours after surgery. Swelling is normal. The vesicostomy will drain urine regularly during the day and night and a diaper or other absorbent cloth should be placed in the area to keep the child dry.
- Activity restrictions: For two to three weeks after the surgery the child should avoid trauma to the surgical area and avoid rough-housing, contact sports, bicycle riding or physical education. Most child are able to return to school within a few days of surgery as tolerated.
Side effect vesicostomy
They’re rare. But when they do occur, they may include:
Bleeding in your scrotum. This can lead to painful swelling. To avoid it, be sure to follow your doctor’s orders before and after surgery.
Infection. This is always a possibility with any procedure
Severe or persistent pain