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What is a vesicostomy?

A vesicostomy is a surgical procedure done while your child is asleep in the operating room. During this surgery, an opening in the lower part of the belly (abdomen) is created between the bladder and the skin, which allows urine to drain easily and constantly out of the bladder. The opening is called a stoma. The stoma will look like a small slit surrounded by some pink tissue. It is typically small, about a finger-width in size. This surgical procedure typically involves an overnight stay in the hospital.


Why is a vesicostomy needed?

Usually, infants or children need a vesicostomy for the following reasons: 

  • Recurrent (many) urinary tract infections 
  • Significant vesicoureteral reflux 
  • Children with high pressure bladders 

Although most children who need vesicostomy are young (under 5 years old), sometimes older children or teenagers need this surgery to help lower bladder pressure and protect the kidneys.

The vesicostomy allows your child’s urine to consistently drain out of the bladder through the stoma.  This helps reduce the pressure in the bladder, the occurrence of urinary tract infections, vesicoureteral reflux (urine going backward, into the kidneys from the bladder) and kidney damage. The vesicostomy can be permanent or temporary, based upon your child’s needs. 


What can I expect during a vesicostomy procedure?

Before surgery, our scheduler and surgery department will be contacting you with specific instructions on how to prepare for your child’s surgery, including the need for a pre-operative evaluation by your primary care provider.  Please follow the instructions exactly about when your child should stop eating and drinking. 

Your child will receive general anesthesia to help them sleep and not feel pain during the surgery. A local block (numbing medicine around the surgical area) will be given. An Opening is made from the abdomen to just below the belly button. The opening allows urine to drain out of the bladder. A catheter (small tube) may be place to help the stoma heal. 

The surgery typically takes about an hour. Your child will go to our recovery area for monitoring immediately after surgery. The surgery can be completed as a same-day procedure and you may be discharged home the day of surgery; some patients may require additional care and monitoring. Your care team will inform you of their recommendation after surgery. 

Your child may be sore around the stoma after surgery. Soreness can be managed by Tylenol or Ibuprofen per package instructions and should improve after a few days. It is normal to experience a small amount of bleeding from the stoma site immediately after surgery.   Most children can return to school or daycare in about a week. Your child may return to bathing and showering immediately. 

You may notice a change in your child’s bowel habits right after surgery. Many children will experience constipation or difficulty having a bowel movement after a surgical procedure due to the anesthesia. Encourage your child to drink plenty of water and if they have not had a bowel movement up to two days after the surgical procedure, please call your primary care provider. 


What are the risks associated with a vesicostomy?

Risks associated with a vesicostomy include:

  • Prolapsing the bladder, meaning that the bladder tissue may start to protrude or “poke out” of the vesicostomy stoma. This can occur if the child has been bearing down or straining, such as when they are crying or during a bowel movement. It is normal for a small amount of pink bladder tissue to be seen but contact our urology team if your child experiences a larger protrusion.  
  • Narrowing of the vesicostomy stoma, which can prevent urine from draining from the bladder. This will need to be evaluated by bladder ultrasound, and if urine is not draining well from the bladder, stoma dilation or stoma revision may be recommended. 

How do I dilate a vesicostomy stoma?

Your surgeon may recommend you dilate (widen) the stoma with a catheter 1-2 times a day. Do this at the same time each day, so it becomes a routine. If your surgeon recommends dilations, the urology nurses will instruct you on the procedure. 

Dilating a Vesicostomy Stoma

  1.  Wash your hands with soap and water 
  2.  Assemble supplies needed: baby wipe or washcloth, catheter, water-soluble lubricant
  3.  Clean the area around the vesicostomy with a baby wipe or washcloth, moving from the opening outward. 
  4.  Apply a water-soluble lubricant to the tip of the catheter. 
  5.  Insert the catheter ½ to 1 inch into the opening of the vesicostomy. 
  6.  Allow urine to drain. 
  7.  Remove the catheter when urine stops draining and wipe area clean if needed.  

Vesicostomy Rehabilitation And Recovery

Your child can resume their regular diet as tolerated. 

Your child may return to school or daycare when pain is well controlled. 

Your child will need to wear a diaper that covers the newly created stoma. Oftentimes, this requires families to place an additional pad over the stoma, such as a feminine pad, to assist with absorbing the urine. The pad and diaper should be changed at regular, frequent intervals to assist with keeping the surrounding skin healthy. Your child may have a catheter in place for a few days after surgery to keep the stoma open during healing. 

Keep the stoma clean and wash the surrounding skin daily with soap and water. Do not use hydrogen peroxide or alcohol, as this can irritate the skin and slow the healing process. Pat dry.  

A barrier cream, such as a diaper cream, can be used on the skin surrounding the stoma to protect it from urine. An antifungal cream can also be used if needed. Please contact our urology team should you have any concerns about the skin surrounding your child’s stoma, particularly if it looks red, crusty, irritated or infected.   

The vesicostomy should be checked daily to ensure that it is still draining urine easily. Over time, the opening may start to get smaller or narrow (stenosis), making it difficult for the urine to drain. Please contact our urology team if you have concerns regarding the size of the opening. 

It is OK to intermittently catheterize the stoma to assist with draining the urine from your child’s bladder or irrigating the bladder with a syringe and sterile saline. Our team can assist with teaching you how to irrigate. 


Your Care Team

Regular follow-up is important for the health of your child. Please attend your follow-up appointments with your urology provider so we can monitor your child’s vesicostomy. Please call Gillette Telehealth (651) 229-3890 or our urology team if you have any questions or concerns. 

This information is for educational purposes only. It is not intended to replace the advice of your health care providers. If you have any questions, talk with your doctor or others on your health care team. If you are a Gillette patient with urgent questions or concerns, please contact Telehealth Nursing at 651-229-3890.