Vesicostomy Information
We were really surprised when the urologist told us that Lizzie needed a vesicostomy. I had read that in rare cases, when there are complications to VUR, a child might need a urinary diversion, but I never expected Lizzie to fall in that category. I needed to know more about what cutaneous vesicostomy was, and how it could help my daughter.
A cutaneous vesicostomy is an opening in the lower abdomen which allows urine to continuously drain from the bladder. A small incision is made into the abdomen and into the bladder. The surgeon will take the edge of the bladder and turn it inside out, and then sew it to the skin of the abdomen. It is a small incision, about an inch or so below the belly button, and the opening is called a stoma.
A vesicostomy is a procedure that is usually done in infants and young children (usually under 5 yrs), but can sometimes be an option for older children and teens. This type of stoma does not require any type of equipment or bags. The urine will drain directly from the stoma into the child’s diaper. A vesicostomy is a temporary urinary diversion, which means that is easily reversed in the future, which makes it a good option for children.
So why would a child need a vesicostomy? Some children are born with or develop an obstruction in their urinary tract. This may include children with posterior urethral valves, vesicoureteral reflux, or neurogenic bladder. The vesicostomy will help prevent urinary tract infections, and kidney damage.
For Lizzie, the vesicostomy has reduced her UTIs, as well as the pressure that builds up in the bladder. We are really pleased at the success of the surgery. Lizzie went from having a kidney infection every single month, to not having one in the past 8 months. It means that she is finally healthy, which in turn means less hospital visits, less doctors, and less meds.
Studies have shown that a vesicostomy can help maintain renal function and prevent damage. Because it is easily reversed, it can be taken down when the child is older, or in a better position to receive other treatments. It has proven very effective in preventing UTI and preserving the bladder.
The surgery is done with general anesthesia, which means your child will be completely asleep during the procedure. The surgery will generally last about an hour, at which time your child will be taken to recovery where you can be with them. Your hospital stay is usually 1-2 days. A catheter may be placed in the new stoma, or the urethra (or sometimes in both, which was the case for Lizzie). The catheter can usually be removed in the first day, but may need to stay in place 2-3 days.
Care for a vesicostomy is pretty basic. You may need to dilate the stoma to keep it from closing. This requires the insertion of a catheter into the stoma to stretch it out. This is often done 2 times a day. For the first week or so, you will keep an antibiotic ointment on the incision to prevent infection, and your child will be prescribed an oral antibiotic as well as pain medication. Your child’s diaper should be changed frequently to prevent skin abrasions from constant wetness. You may want to use Vaseline as a barrier to protect the skin if needed. We have also found that because of Lizzie’s daily antibiotics, yeast infections have been a struggle with the vesicostomy, and at times a barrier cream has helped with the rash.
After the surgery, you should call your doctor immediately if any of the following occur:
- If no urine has passed through the stoma in 2-3 hours
- Foul smelling or discolored urine
- Tearing or significant bleeding of the stoma
- Fever over 101.4 degrees F
Diapering a child with a vesicostomy can sometimes be tricky, and we have found it to be the most difficult part of the vesicostomy. For more tips on diapering, and keeping your child dry, please click here.
Lizzie's Journey 