Name of the Procedure:

Cutaneous Vesicostomy
Common name(s): Vesicostomy

Summary

A cutaneous vesicostomy is a surgical procedure that creates an opening in the lower abdomen to allow urine to drain directly from the bladder to the skin's surface. This is typically done to bypass blockages or other issues affecting normal urinary flow.

Purpose

Cutaneous vesicostomy addresses urinary obstruction or retention issues often caused by congenital conditions, bladder dysfunction, or neurogenic bladder. The primary goal is to prevent urinary tract infections and kidney damage by ensuring adequate urine drainage.

Indications

• Severe urinary tract obstruction
• Neurogenic bladder
• Recurrent urinary tract infections
• Vesicoureteral reflux
• Conditions not responsive to other treatments

Patient criteria:

• Typically pediatric patients with congenital urological issues
• Patients with compromised bladder function

Preparation

• Pre-procedure fasting typically 6-8 hours before surgery.
• Adjustments to current medications as advised by the healthcare provider.
• Pre-operative blood tests and imaging studies to assess bladder function and anatomy.

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made in the lower abdomen.
3. The surgeon locates and opens the bladder, bringing its wall up to the skin.
4. The bladder wall is then sutured to the edges of the skin incision, creating a stoma.
5. A tube or catheter may be temporarily placed to ensure the opening remains patent.

Tools: Surgical scalpel, suturing materials, catheter
Anesthesia: General anesthesia is commonly used.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

• Hospital operating room
• Specialized pediatric surgical centers

Personnel

• Pediatric urologist or general urologist
• Surgical nurse
• Anesthesiologist

Risks and Complications

• Infection at the surgical site
• Blockage or stenosis of the vesicostomy
• Urine leakage around the stoma
• Skin irritation around the stoma
• Bladder spasms or discomfort

Benefits

• Improved urine drainage
• Reduced risk of urinary tract infections
• Prevention of kidney damage
• Immediate improvement in symptoms post-surgery

Recovery

• Initial hospital stay of 2 to 3 days to monitor recovery.
• Regular stoma care to keep the area clean and prevent infection.
• Follow-up appointments for stoma assessment and management.
• Most patients can resume normal activities within a few weeks.

Alternatives

• Urethral catheterization: less invasive but may have a higher risk of infection.
• Suprapubic catheter placement: another surgical option but might not be suitable for all patients.
• Clean intermittent catheterization: requires regular catheter insertion through the urethra.

Patient Experience

• Post-procedure discomfort managed with analgesics.
• May experience bladder spasms initially, treatable with medications.
• Learning and adapting to stoma care, often supported by a healthcare team.
• Patients and caregivers receive education on stoma maintenance to prevent complications.