Vesicostomy: Procedure, Benefits, Risks, Recovery and Alternatives

Vesicostomy is a life-changing surgical procedure, particularly for children and infants with severe bladder dysfunction or obstruction. Designed to protect the kidneys and urinary tract when other treatments are ineffective or unsuitable, vesicostomy provides an alternative pathway for urine to exit the body. In this article, we break down the vesicostomy procedure, explore its benefits and risks, discuss recovery and aftercare, and examine alternative options, all supported by the latest research evidence.

Vesicostomy: The Procedure

When conservative or minimally invasive treatments fail to relieve severe bladder outlet obstruction or dysfunction, vesicostomy offers a straightforward surgical solution. The operation involves creating a small opening (stoma) from the bladder to the lower abdomen, allowing urine to bypass the urethra and exit directly into a diaper or collection device. This temporary or, in some cases, permanent diversion protects the kidneys from pressure and infection while stabilizing the patient's condition.

Indication	Description	Age Range	Source
Bladder Outlet Obstruction	Blocked flow due to PUV, neurogenic bladder	From neonates to teens	1,2,4,8
Surgical Technique	Blocksom, Schlegel-Mobley, Button, others	Neonates to adults	2,11,12,16
Procedure Duration	Simple, quick (often under 1 hour)	Infants, children, adults	2,11,12
Reversibility	Temporary or permanent diversion	Reversible in most cases	2,6,14

Table 1: Key Features of the Vesicostomy Procedure

Indications for Vesicostomy

Vesicostomy is primarily indicated for children with:

• Posterior urethral valves (PUV), which block urine flow
• Neurogenic bladder (bladder dysfunction due to nerve problems, as seen in spina bifida)
• Severe or recurrent urinary tract infections (UTIs)
• Hydronephrosis (swelling of the kidneys due to urine buildup)
• Failure of less invasive treatments, such as clean intermittent catheterization (CIC) 1,2,4,6,8

Surgical Techniques

Several surgical methods exist:

• Blocksom technique: The bladder is brought to the skin and sutured in place 2,13
• Button vesicostomy: A gastrostomy button or similar device creates a continent (controlled) urinary stoma 11,12
• Schlegel-Mobley method and other modifications offer different approaches for stoma creation 16
• Hidden/continent vesicostomy: Stoma is placed for improved continence and cosmetic outcome 17,18

The procedure is usually brief and well-tolerated, even in neonates and infants. Vesicostomy offers a reversible way to relieve urinary obstruction and protect kidney function until definitive surgery is possible or until the patient is older and able to manage other treatments 2,6,14.

Benefits and Effectiveness of Vesicostomy

Vesicostomy is valued for its ability to quickly and effectively protect the upper urinary tract, resolve infections, and stabilize kidney function in vulnerable patients. It serves as a temporary "rest" for the bladder and buys time for more definitive treatments.

Benefit	Outcome Achieved	Success Rate/Impact	Source
Kidney Protection	Stabilizes or improves function	80–95% improvement	2,4,8,13
Infection Control	Reduces febrile UTIs, sepsis	85–95% cure rate	2,4,6,8
Hydronephrosis	Resolves or lessens kidney swelling	80–90% improvement	2,4,13
Reversibility	Temporary diversion, closure possible	50–70% stoma closure rate	2,7,8

Table 2: Benefits and Effectiveness of Vesicostomy

Kidney and Upper Tract Protection

Vesicostomy is highly effective at:

• Reducing or eliminating hydronephrosis (kidney swelling from urine backup)
• Improving or stabilizing kidney function, measured by creatinine and GFR 2,4,8,13
• Preventing irreversible kidney damage in children at high risk

Infection Reduction

The procedure dramatically decreases the frequency and severity of urinary tract infections, including life-threatening febrile UTIs and sepsis. In many series, 85–95% of children experience resolution of infections after vesicostomy 2,4,6,8.

Improved Quality of Life and Reversibility

For most patients, vesicostomy is temporary. Once the underlying cause is corrected or the child matures, the stoma can be closed and normal or near-normal voiding may resume 2,7,8. In select cases, particularly in children with severe, permanent bladder dysfunction, vesicostomy can be maintained long-term or even permanently with good results 14.

Risks and Side Effects of Vesicostomy

Like any surgical intervention, vesicostomy carries risks and potential complications. However, most are minor and manageable with proper care.

Complication	Description	Frequency/Severity	Source
Stoma Stenosis	Narrowing of stoma	4–11% (minor, repairable)	1,8,16
Mucosal Prolapse	Bladder lining protrudes	4–7% (can recur)	1,8,10,16
Infection	Local or UTI	3–10% (usually minor)	4,10,11,12
Dermatitis	Skin irritation around stoma	Up to 42% in infants	10,8
Major Complications	Severe infection, device failure	Rare (<5%)	12,2

Table 3: Risks and Side Effects of Vesicostomy

Common Complications

• Stoma stenosis: The stoma may become narrowed, requiring dilation or revision 1,8,16
• Mucosal prolapse: Bladder lining can protrude through the stoma, sometimes needing surgical correction 1,8,10
• Local skin irritation: Diaper dermatitis or skin breakdown can occur, especially in young children 10
• Infections: While vesicostomy often reduces UTIs overall, some children may experience local or recurrent infections 4,10,11,12

Rare and Serious Risks

• Major infections: Rare but possible, including abscess or severe UTI, sometimes leading to sepsis 1,12
• Device failure or significant leakage: More common with button vesicostomy or in cases of poor healing 12
• Renal stones: Occasional occurrence, particularly in long-term, permanent vesicostomies 14

Managing Risks

Most complications are minor and manageable. Regular follow-up, good stoma care, and prompt attention to any changes help minimize risks.

Recovery and Aftercare of Vesicostomy

Recovery from vesicostomy is generally rapid, particularly in children. However, ongoing care of the stoma and monitoring for complications are vital for long-term success.

Recovery Aspect	Details	Patient Experience	Source
Hospital Stay	Short (typically 1–3 days)	Quick discharge	2,13
Stoma Care	Daily cleaning, skin protection	Family/caregiver training	13,4,10
Activity	Return to normal, age-appropriate	Minimal restriction	13,4
Stoma Closure	Possible after recovery or growth	50–70% closure rate	2,7,8

Table 4: Recovery and Aftercare Factors

Immediate Postoperative Recovery

• Most children recover quickly and are discharged within a few days.
• Pain and discomfort are typically mild and well-controlled with standard medications 2,13.

Stoma Care and Family Adaptation

• Daily cleaning of the stoma and surrounding skin is essential to prevent irritation and infection.
• Parents and caregivers are trained to manage the stoma and recognize complications 13,4.
• Most caregivers adapt well, reporting high satisfaction and positive adjustment 13.

Long-Term Follow-up

• Ongoing monitoring of kidney function, bladder health, and stoma condition
• Periodic imaging (ultrasound) and laboratory tests are standard 4,13
• For many, vesicostomy is closed once the underlying problem is resolved or when the child is ready for other management options 2,7,8.

Quality of Life

• Children can participate in most normal activities.
• For those with button or continent vesicostomies, continence and body image may be improved 11,12,17.

Alternatives of Vesicostomy

While vesicostomy is a reliable tool, several alternative interventions exist for managing severe bladder dysfunction or outlet obstruction.

Alternative	Description	Suitability	Source
Primary Valve Ablation	Endoscopic removal of PUV	First-line for PUV if feasible	1,7,9
Clean Intermittent Catheterization (CIC)	Regular catheterization to empty bladder	Preferred if feasible, often fails in infants or some neurogenic bladders	2,11,12
Suprapubic Catheter	Tube placed directly into bladder	Temporary option, less favored in young children	11
Continent Diversion (Mitrofanoff, etc.)	Surgical creation of catheterizable stoma	Used in older children or when vesicostomy is not suitable	11,12,17,18
Bladder Augmentation	Surgical enlargement of bladder	For refractory, high-pressure bladders	8,14

Table 5: Alternatives to Vesicostomy

Primary Valve Ablation

• First-line for posterior urethral valves (PUV) if endoscopic facilities are available and the patient is stable 1,7,9.
• Vesicostomy is often reserved for situations where ablation cannot be performed safely or is unsuccessful.

Clean Intermittent Catheterization (CIC)

• Preferred long-term management for neurogenic bladder if the child or caregiver can perform it reliably.
• Not always feasible in infants, those with complex anatomy, or when repeated infections occur 2,11,12.

Button Vesicostomy and Other Continent Diversions

• A button vesicostomy allows for intermittent drainage and can be an alternative when CIC is not possible 11,12.
• More complex surgical options like Mitrofanoff appendicovesicostomy provide catheterizable, continent urinary drainage for select patients 17,18.

Bladder Augmentation and Other Surgeries

• Bladder augmentation or reconstruction is reserved for patients with persistent high-pressure bladders, refractory infections, or upper tract deterioration despite other measures 8,14.
• These are more invasive and carry their own risks.

Conclusion

Vesicostomy remains a vital and effective surgical option for children and select adults with severe bladder dysfunction or obstruction, especially when other therapies have failed or are not feasible. It is a relatively simple, reversible procedure that provides reliable protection for the kidneys and urinary tract, greatly reduces infections, and improves quality of life. While there are risks, most are minor and manageable with good care and follow-up. Multiple alternatives exist, but vesicostomy fills an important niche—especially for infants and children awaiting further growth or recovery.

Key Points:

• Vesicostomy is indicated for severe bladder outlet obstruction, neurogenic bladder, and recurrent infections unresponsive to conservative therapy.
• The procedure is simple, quick, and often reversible, with several surgical techniques available.
• Benefits include protection of kidney function, reduction in urinary tract infections, and resolution of hydronephrosis.
• Risks are generally minor (stoma stenosis, prolapse, skin irritation); major complications are rare.
• Recovery is rapid, with most families adapting well to stoma care and reporting high satisfaction.
• Alternatives such as primary valve ablation, CIC, and bladder augmentation are available; vesicostomy is used when these are unsuitable or have failed.

Vesicostomy, backed by decades of clinical experience, continues to offer hope and protection for the most vulnerable patients facing complex urinary tract challenges.