What is the surgical creation of an artificial opening between the kidney and the body surface to temporarily drain urine?

Health Library Vesicostomy Care

Inhaltsverzeichnis Show

• Health Library Vesicostomy Care
• How Do You Care for a Vesicostomy?
• Caring for a Vesicostomy at Home
• Dilating (Stretching) a Vesicostomy
• Call Your Child's Doctor If:
• Contact Us
• Overview
• What is urinary reconstruction and diversion?
• Urinary tract anatomy
• What are the urinary diversion options?
• Recovery and Outlook
• What can I expect after urinary reconstruction and diversion?
• What restrictions will I face after urinary reconstruction and diversion?
• What is the surgical creation of an artificial opening between the kidney and the body surface?
• What is the creation of an artificial opening into the kidney?
• What is urostomy surgery?
• What is the difference between a urostomy and nephrostomy?

How Do You Care for a Vesicostomy?

A vesicostomy is an opening created by the doctor between the abdominal wall and the bladder. This helps prevent harm to the kidneys. This surgery is done in the operating room. The opening looks like a small slit with pink tissue all around it. Urine drains constantly from this opening, and the child will need to wear a diaper, pull-ups or an incontinence pad, such as Poise pads. A vesicostomy is a temporary treatment. 

This surgery is a needed step for some children to help prevent urinary tract infections and/or harm to the kidney. Most children who need a vesicostomy are young (under 5 years old), but sometimes older children or teenagers need this surgery temporarily.

Caring for a Vesicostomy at Home

The opening of the vesicostomy will slowly close if it is not stretched at regular intervals. Stretching (also called dilating) the opening with a catheter one to two times a day is needed. It is best to do this at the same time each day. It can be normal for a very small amount of bleeding to occur from the stoma during stretching.  Urine should drain constantly from the opening.

Once in a while, the skin around the vesicostomy may become red, irritated and sore. If this happens, your doctor may give you a special medicine or ointment to treat the skin.

Dilating (Stretching) a Vesicostomy

1. Wash your hands with soap and water.
2. Clean the area around the vesicostomy with Betadine or BZK in a circle like motion. Move from the opening out.  Clean with three different swabs or wipes.
3. Apply a water-soluble lubricant to the tip of the catheter.
4. Insert the catheter ½ to 1 inch into the opening of the vesicostomy.
5. Turn the catheter back and forth
6. Remove the catheter and clean the opening to remove the Betadine or BZK from the skin.

Call Your Child's Doctor If:

• Urine does not drain from the opening for two hours
• The skin around the opening looks red, crusty, irritated or infected
• You are unable to pass the catheter into the opening
• Tissue is coming out from the vesicostomy opening
• The child complains of pain
• There is blood in the urine (more than the normal amount that occurs with stretching of the vesicostomy)
• Your child has a fever higher than 101.5°F (38.6°C)

Last Updated 07/2021

Reviewed By Lisa Smith, RN

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For more information or to request an appointment, contact the Division of Urology.

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a surgical incision into the kidney is a

abnormal hardening of the kidneys is known as

prolapse of the bladder into the urethra is known as

a prolapse of the female urethra is a

the procedure to separate adhesions around a ureter is

abnormal softening of the kidney is known as

inflammation of the renal pelvis and kidney is known as

the surgical creation of an outside excretory opening from the urethra is

the surgical repair of the bladder is a

Overview

What is urinary reconstruction and diversion?

When your urinary bladder is removed (due to cancer, other medical conditions or because the organ no longer works), you need another way to pass urine through your body (pee). Urinary reconstruction and diversion are types of surgery done to help you do this.

Urinary tract anatomy

The urinary tract normally consists of two kidneys, two ureters, a urinary bladder and a urethra:

• The kidneys filter your blood and remove water and waste through the urine.
• The urine travels from the kidney to the bladder through tubes called ureters.
• The urine is stored in the urinary bladder, and then moves through the urethra to be passed out of the body when you urinate.

When the bladder is removed, urine needs to exit the body in a new way, through a urinary diversion. In all of the types of urinary diversions, a part of the intestine is surgically converted to either 1) a passage tube for urine to exit the body, or 2) a reservoir to store urine (like a normal bladder).

Regardless of surgical method, urine and stool remain completely separate from each other. (They are two different systems — the urinary and digestive systems — respectively.)

What are the urinary diversion options?

There are three main types of urinary diversion surgeries:

• Ileal conduit urinary diversion.
• Indiana pouch reservoir.
• Neobladder-to-urethra diversion.

For all of these procedures, a portion of the small and/or large bowel is disconnected from the fecal stream and used for reconstruction.

Ileal conduit urinary diversion

Ileal conduit urinary diversion: A segment of the intestine directs urine through a stoma into an external collecting bag.

With this procedure, the ureters (the tubes that carry urine from the kidneys to the bladder) drain freely into part of the ileum (the last segment of the small intestine). The end of the ileum into which the ureters drain is then brought out through an opening in the abdominal wall. This opening, called a stoma, is covered with a bag that gathers the urine as it drains from the ileal conduit.

Advantages and disadvantages

The advantages of the ileal conduit urinary diversion surgery are:

• It is a relatively simple surgery.
• It requires less surgical time (compared with other surgical methods).
• There is no need for occasional catheterization (use of a tube to drain the urine)

The disadvantages of the ileal conduit urinary diversion are:

• There’s a change in body image.
• It uses an external bag to collect urine, which might leak or have odors.

Indiana pouch reservoir

Indiana pouch reservoir: A pouch is made out of portions of intestines stores urine until it is drained via a catheter inserted through the stoma.

With this type of surgery, a reservoir or pouch is made out of a portion of the large intestine (the ascending colon on the right side of the abdomen) and a portion of the ileum (the last segment of the small intestine). The ureters are repositioned to drain into this pouch. The urine flows freely in a downward direction from the kidneys into the pouch. This positioning prevents urine from backing up into the kidneys, which protects the kidneys from infection. A short piece of small intestine is then brought out through a small opening in the abdominal wall (a stoma). The stoma is very small and can be covered with an adhesive bandage.

Unlike the ileal conduit, no external bag is needed. Instead, a one-way valve is surgically created to keep the urine inside the pouch. Several times a day (usually every four hours around the clock), a small, thin catheter must be passed through the stoma and into the pouch to empty the urine. An adhesive bandage is worn over the stoma at all other times (when not actively emptying the pouch).

Most insurance policies will allow you to have enough catheters so that you can use a new one each time. If your policy doesn’t, or if you run out, catheters can be washed with soap and water and reused. The catheters don’t have to be sterilized. They can be taken on trips or social events and simply stored in a plastic bag.

Advantages and disadvantages

The advantages of the Indiana pouch reservoir surgery are:

• Urine is kept inside the body, in the reservoir, until it’s ready to be emptied.
• No external bag is necessary.
• There is no odor.
• The risk of urine leaking is minimal.
• The small stoma can be covered with an adhesive bandage.

The disadvantages of the Indiana pouch are:

• The surgery takes longer compared with the ileal conduit.
• There is the need for occasional catheterization (the passing of tubing into the stoma to empty the pouch), every four hours around the clock.

Neobladder-to-urethra diversion

Neobladder-to-urethra diversion: Intestine is made into a reservoir and connected to the urethra.

This procedure most closely resembles the storage function of a urinary bladder. A small part of the small intestine is made into a reservoir or pouch, which is connected to the urethra. The ureters are repositioned to drain into this pouch.

Urine is able to pass from the kidneys, to the ureters, to the pouch, and through the urethra in a manner similar to the normal passing of urine. To empty the pouch, you need to contract (tighten) your abdominal muscle.

To be a candidate for this surgery, there must be a low risk of cancer recurrence (return) in the urethra. Occasionally, people aren’t able to empty adequately by contracting their abdominal muscles. In these cases, they must pass a catheter into the urethra to empty the pouch, up to six times a day. If this isn’t something you’re willing or able to do, you probably shouldn’t consider this type of diversion.

Advantages and disadvantages

The advantages of the neobladder-to-urethra diversion are:

• The process of urination most closely matches normal urination.
• No stoma is needed.

The disadvantages of the neobladder-to-urethra diversion are:

• Surgery time is slightly longer than the ileal conduit urinary diversion procedure.
• While regaining control of urination, urinary incontinence (leakage of urine) is normal after surgery, but might last up to six months. Also, about 20% of patients during the night and 5% to 10% of patients during the day are incontinent (leak urine) and have to wear a pad.
• Despite the surgery, some patients might not be able to empty their bladder well and will need to perform occasional catheterization (passing tubing through the urethra into the pouch every four hours) for a prolonged period of time after surgery, and perhaps permanently.

Recovery and Outlook

What can I expect after urinary reconstruction and diversion?

After urinary reconstruction and diversion, it takes one to two months to feel well again and to regain your strength. Don't hesitate to call your doctor or other healthcare team members for assistance or if you have questions. Their goal for you is to get you back to your lifestyle as soon as possible.

What restrictions will I face after urinary reconstruction and diversion?

People with urinary diversions are usually able to return to the life, work and hobbies they previously enjoyed:

• Work: Most people can return to their jobs in one or two months, on average. If you have concerns about your line of work or other job hazards, be sure to ask your doctor.
• Activities: After the post-operative period, exercising and participation in sports and other activities is encouraged. Check with your doctor or healthcare team member.
• Diet: There are no eating restrictions. If you have special dietary concerns, ask your doctor or health care team member.
• Travel: There are no travel restrictions. You should travel fully prepared with necessary supplies, as you might not be able to purchase all supplies at your destination.

A note from Cleveland Clinic

As with any life change, an adjustment period is normal after a major surgery. It's not unusual to feel a little depressed or discouraged. Talk about your feelings with friends and family. If you join a support group, other members may be able help you deal with your emotions. (Ask your healthcare team member about support groups in your area.)

What is the surgical creation of an artificial opening between the kidney and the body surface?

What is the creation of an artificial opening into the kidney?

What is urostomy surgery?

What is the difference between a urostomy and nephrostomy?