It's hard to put into words the fear and anxiety that a mother or father feels when they are told that their young child needs to undergo surgery. It can be a very painful experience, especially when the child is unable to
urinate on their own. But if your doctor has talked about a vesicostomy, don't worry. This is a very safe, temporary solution to stop the damage to your child's kidneys. Let's clear up any questions you may have about this today.
Simply put, what is this Vesicostomy?
A vesicostomy is a surgical procedure that allows a child to empty their bladder when they have difficulty urinating on their own. In this procedure, a surgeon
makes a very small opening in the child's abdomen, usually just below the navel. The difference is that the urine drains directly into the diaper, rather than into a bag attached to the abdomen. The main purpose of this procedure is
to prevent urine from flowing back into the kidneys, damaging the kidneys and causing urinary tract infections (UTIs). The important thing is that this is not a permanent solution. It is just a temporary measure until the underlying cause of the child's inability to urinate is treated.
Why does a young child need a vesicostomy?
When a child's bladder does not empty properly, the pressure inside it increases and urine starts to flow back up into the kidneys. This can cause serious damage to the kidneys. There are several main reasons why a vesicostomy may be needed.
| Condition/Cause | A simple explanation |
|---|
| Spina bifida or neurogenic bladder | Inability to properly urinate due to a birth defect or weakness in the spinal cord or nerves that control the bladder. |
| Vesicoureteral reflux (VUR) | Urine flows backward from the bladder towards the kidneys. |
| Bladder outlet obstruction | There is some obstruction in the path of urine leaving the bladder. |
| Recurring UTIs | Frequent infections due to improper urination. |
| Other birth defects | Conditions such as Prune belly syndrome, which is caused by a birth defect. |
This surgery is often performed on children
under the age of 5. However, very rarely, it is performed on older children.
How to prepare a child before surgery?
Your doctor will give you clear instructions about this.
- Inform the doctor about any medications your child is taking and any allergies your child may have.
- Your doctor will tell you exactly when to stop feeding your baby (including breast milk and formula ) before surgery. It is very important to follow these instructions exactly.
After the child is taken to the operating room, they are given
general anesthesia . This means that the child is completely asleep and
does not feel any pain. The surgeon then makes a small incision in the child's abdomen, makes a small opening in the bladder, and arranges the opening so that it comes out through the opening made in the abdomen. The entire procedure takes
about an hour or two . After the surgery, there is one small thing you can do. The doctor will tell you to put a small catheter into the opening several times a day
to stretch it. This is to stop the opening from closing too quickly. The hospital will tell you exactly how to do this and how long to do it.
What happens after the surgery? How do you take care of the baby?
This is the most important part for parents.
Hospital stay and pain
Most children can go home a few hours after surgery. Sometimes, they may need to stay in the hospital overnight for observation. There may be some pain after surgery. This can be relieved by taking a painkiller (such as ibuprofen or acetaminophen) prescribed by the doctor. The pain should go away completely in a few days.
Care after returning home
- Cleanliness: Keeping the skin around the incision and the area clean and dry is essential to prevent infection.
- Changing nappies: Change nappies regularly as usual. Use a nappy that is large enough to cover the opening well.
- Skin allergies : It is common for skin rashes to appear around the opening. You can use a diaper rash cream recommended by your doctor for this.
- Activities: The child can return to preschool or school in about a week. However, activities that could damage the opening, such as wrestling, bicycling , and running should be avoided for a while.
There are usually no major complications, but if you experience any of the symptoms below, you should
contact your doctor immediately .
| When to seek immediate medical advice |
|---|
| 🌡️ | If the child has a high fever . |
| 🔴 | If the area around the opening is severely red, swollen , or shows signs of infection. |
| 🩸 | If there is blood in the urine. |
| 😫 | If the child's pain persists despite medication. |
| 🚫 | If the catheter provided to widen the opening cannot be inserted . |
| ⚠️ | If part of the bladder has come out of the opening (bladder prolapse) and cannot be pushed back in. (This can happen during a bowel movement, such as when a child has a bowel movement. It usually goes back in on its own. If not, you can gently push it in with clean fingers. But if it doesn't, talk to your doctor .) |
Take-Home Message
- A vesicostomy is nothing to be afraid of. It is a very safe and temporary surgery done to protect the child's kidneys.
- After surgery, it is extremely important to follow your doctor's instructions exactly, especially keeping the incision clean and stretching it properly.
- This is not permanent. After the child's underlying condition is treated, the surgeon will close this opening.
- If you have any doubts or questions, never think twice about asking your doctor.
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