A vesicostomy is a surgical procedure that creates a temporary opening, known as a stoma, allowing urine to drain from the bladder directly to the outside of the body through the abdominal wall. This opening is typically made just below the belly button and is primarily performed on infants and young children who have difficulty emptying their bladder naturally. Designed to bypass a blockage or dysfunction in the lower urinary tract, the vesicostomy provides a continuous, low-pressure outlet for urine. This protects the upper urinary system, specifically the kidneys, from damage while a child grows or awaits a more definitive treatment.
Defining the Procedure and Its Purpose
The medical necessity for a vesicostomy arises from conditions that cause high pressure or obstruction within the bladder, which can force urine backward toward the kidneys, a process called reflux. This backflow of urine can lead to recurrent urinary tract infections (UTIs) and cause permanent damage to the delicate kidney tissue. The procedure’s main goal is to prevent this kidney damage by ensuring the bladder pressure remains low and urine drains freely.
Several serious conditions often necessitate this intervention, including Posterior Urethral Valves (PUV), which are tissue flaps that can block the urethra in males, and Neurogenic Bladder, a dysfunction often associated with conditions like spina bifida. Severe Vesicoureteral Reflux (VUR), where urine travels up the ureters to the kidneys, is another common indication, especially when less invasive treatments have not been successful. By relieving the pressure and allowing continuous drainage, the vesicostomy acts as a protective measure for the upper urinary system until a child is old enough for reconstructive surgery or the underlying issue resolves.
How the Vesicostomy Procedure is Performed
The creation of a vesicostomy is a relatively brief operation, typically performed under general anesthesia. The surgeon begins by making a small incision in the lower abdomen, usually in the midline just beneath the umbilicus. This location is chosen for easy access and care, as it sits above the pubic bone.
The bladder wall is then accessed through this opening, and a portion of the bladder is brought forward to the surface of the skin. The edges of the bladder opening are carefully stitched directly to the abdominal skin, creating the stoma. The resulting opening is small, often described as a slit surrounded by reddish-pink tissue, and allows for immediate, continuous urine drainage into the diaper. Most procedures take less than an hour, and many children only require a short hospital stay for monitoring.
Daily Care and Management of the Stoma
Caring for a vesicostomy stoma primarily involves maintaining hygiene and protecting the surrounding skin from irritation caused by constant urine exposure. Since urine drains continuously, the child must wear a diaper or an absorbent pad that should be changed frequently to keep the area dry. Some caregivers find it helpful to place the diaper on backward or use an extra absorbent pad over the stoma to manage the drainage.
To prevent skin breakdown, the stoma site should be washed daily with warm water and a mild soap, then patted completely dry. Applying a skin barrier cream, such as petroleum jelly or zinc oxide ointment, to the skin immediately surrounding the stoma provides a protective layer against the acidic nature of urine. Caregivers must routinely monitor the stoma and skin for any changes, as redness, crusting, or excessive irritation may signal a need for specialized topical treatment.
Care also includes vigilance for signs of potential complications, such as stoma narrowing (stenosis), which can impede urine flow. If urine stops draining for several hours, or if the child develops a fever, these signs warrant immediate medical attention. Another possible issue is prolapse, where a small amount of pink bladder tissue protrudes from the opening, often when the child is straining or crying. While a minor protrusion may be normal, any significant or persistent prolapse needs to be evaluated by a healthcare provider.
Stoma Closure and Reversal
The timing of vesicostomy removal is determined by the resolution of the underlying urinary tract issue. The procedure is typically reversed when the child has grown and is ready for a more permanent reconstructive surgery, or when the bladder function has matured enough to manage urine storage and emptying effectively. The decision to close the stoma is made after a thorough urological evaluation confirms that the kidneys will remain protected without the diversion.
The reversal procedure involves another operation under general anesthesia, where the surgeon carefully separates the bladder tissue from the abdominal skin. The opening in the bladder is then closed with sutures, restoring the integrity of the urinary reservoir. Finally, the abdominal wall incision is closed and repaired, leaving a small scar where the stoma once was. Recovery following stoma closure is usually straightforward, and the child’s urinary function is monitored closely as they transition back to voiding through the urethra.