Vesicostomy in Children: Purpose, Procedure, Care and Recovery
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is a vesicostomy?
A vesicostomy is a procedure that creates an opening from a child's bladder through the lower abdomen so urine can drain when the child has trouble emptying the bladder. It is usually temporary and most often used in young children, with urine draining into the diaper. Contact the care team for high fever, incision redness or blood in the urine.
What the research says
In children with spina bifida whose bladder care with catheterization had not protected the urinary tract, vesicostomy was associated with improvement. In a series of 16 children (mean age at surgery 36.5 months; mean follow-up 7.4 years), hydronephrosis resolved or improved in 12 of 14, urinary tract infections fell to one or fewer per year in 10, vesicoureteral reflux resolved or improved in nine, and kidney function improved or stabilized in six of seven. Complications occurred in three of 15 children, and the vesicostomy was closed in six patients, four of whom needed bladder augmentation (Morrisroe et al., BJU Int, 2005).
Febrile urinary tract infections became less frequent after vesicostomy, but bladder prolapse was the most common complication. In a retrospective review of 28 children at one center, the incidence of febrile UTI fell from 0.058 to 0.012 episodes per person-year (p < 0.001). Mucosal prolapse of the bladder occurred in six children (21.4%), and severe constipation was considered a risk factor for prolapse (Kobayashi et al., Nihon Hinyokika Gakkai Zasshi, 2019).
A vesicostomy may work as a bridge rather than a fix for the bladder itself. In a retrospective study of 38 children with spina bifida who had a vesicostomy at a median age of 16 months (median follow-up 6.1 years), hydronephrosis, high-grade reflux and febrile UTIs improved. Eight children (21%) had the vesicostomy reversed; before reversal their bladders still showed high pressures and low capacity, and the authors advise counseling caregivers that further bladder procedures are typically needed after reversal (Jeng et al., J Pediatr Urol, 2025).
What is a vesicostomy?
A vesicostomy is a procedure that allows urine to drain from a child's bladder when the child has trouble emptying it independently. A surgeon creates a small opening in the child's lower abdomen, usually just below the belly button, and positions an opening from the bladder through the abdomen.
The urine drains directly into the child's diaper. It does not drain into a colostomy bag. The opening provides an alternate route for bladder drainage while the care team addresses the underlying reason the child cannot empty the bladder.
Why might a child need a vesicostomy?
A child may need a vesicostomy when they cannot empty the bladder on their own. When urine cannot leave the bladder normally, pressure can build up and urine may reflux toward the kidneys, which can damage them.
Medical references list several conditions and problems associated with vesicostomy, including spina bifida or neurogenic bladder, vesicoureteral reflux, a spinal cord injury or nervous system disorder, bladder outlet obstruction, congenital urological anomalies, prune belly syndrome and recurring urinary tract infections.
Reason listed | Why it may relate to vesicostomy |
Spina bifida or neurogenic bladder | May interfere with the child's ability to empty the bladder. |
Vesicoureteral reflux | Urine can move backward toward the kidneys. |
Spinal cord injury or nervous-system disorder | May affect bladder control or emptying. |
Bladder outlet obstruction | Can prevent urine from leaving the bladder normally. |
Congenital urological anomaly | A urinary-tract difference present from birth may affect drainage. |
Prune belly syndrome | Is listed among the conditions associated with the procedure. |
Recurring urinary tract infections | May occur in the context of ongoing bladder-emptying problems. |
There is no set age for a vesicostomy. Most children who receive one are younger than 5 years old, while older children and teenagers having a vesicostomy is uncommon but possible.
A condition listed in a medical article is not a diagnosis and does not mean every child with that condition needs a vesicostomy. The child's pediatric urology team makes that decision after evaluating the individual situation.
Is a vesicostomy temporary?
Yes. A vesicostomy is usually a temporary measure while healthcare professionals determine long-term treatment for the underlying reason the child cannot empty the bladder. The treating team explains how long the child may need the opening.
Eventually, the surgeon closes the opening. The timing depends on the child's treatment plan and should be discussed with the care team.
Question | Answer |
Is it permanent? | No. It is usually temporary. |
Why is it used? | To drain urine while the underlying bladder-emptying problem is being evaluated or treated. |
How long is it needed? | The child's healthcare team determines the timeframe. |
What happens later? | The surgeon eventually closes the opening. |
How should a child be prepared?
The child's healthcare professional provides preparation instructions. Caregivers should share a complete list of medications the child takes and report known allergies.
The care team also explains when the child must stop or restrict food and beverages before surgery. This includes breast milk or formula when applicable. Follow the individualized fasting instructions exactly.
Preparation item | What caregivers should do |
Medications | Tell the care team about every medication the child takes. |
Allergies | Report known allergies. |
Food and beverages | Follow instructions about when to restrict intake before surgery. |
Breast milk or formula | Ask when restrictions apply if the child receives either. |
Questions | Ask the surgeon what to expect during the operation and recovery. |
Do not make independent changes to the child's medications or feeding schedule. Use the instructions provided by the treating team.
What happens during vesicostomy surgery?
The surgeon performs the vesicostomy in an operating room. An IV is inserted to deliver medication through a vein, and the child receives general anesthesia so they do not feel pain during the procedure.
The surgeon makes a small incision in the lower abdomen, creates an opening in the bladder and positions that opening through the abdominal wall. Urine can then drain from the bladder through the vesicostomy opening.
The surgeon may ask caregivers to place a catheter through the opening a few times a day. This helps prevent the opening from closing too soon. Caregivers receive instructions about how and when to stretch the opening.
How long does vesicostomy take?
A vesicostomy takes about one to two hours. The surgeon can explain what to expect while the child is in the operating room.
Is vesicostomy painful?
The child should not feel pain during the procedure because of general anesthesia. Some discomfort can occur after the anesthesia wears off. The child's healthcare professional explains which pain medicine to use; sometimes prescription medicine is needed.
What happens after surgery?
Many children can go home several hours after recovering in the recovery room. Some children stay overnight in the hospital for monitoring.
Most children have only a small amount of pain afterward, and the pain should completely subside within a few days. The child's healthcare professional explains what medicine can be used.
Many children can return to daycare or school within about a week. Activities that could damage the opening, such as wrestling, roughhousing, riding a bike or running, should be avoided until the care team says they are safe.
Early recovery topic | What to expect |
Hospital stay | Many children go home several hours later; some stay overnight for monitoring. |
Pain | Usually small in amount and expected to subside within a few days. |
Daycare or school | Many children can return within about a week. |
Activity | Avoid wrestling, roughhousing, bike riding and running until advised. |
Diaper | Use one large enough to cover the opening and hold urine. |
Follow-up care | Follow instructions for keeping the opening open and caring for the skin. |
How should caregivers care for the vesicostomy opening?
The child needs a diaper large enough to cover the opening and hold urine. Keeping the skin around the opening clean and dry helps prevent infection.
Rashes and irritation around the skin opening are common. The child's healthcare professional explains how to care for the area, and diaper-rash cream or ointment may be an option. Diaper changes otherwise follow the child's usual routine unless the care team provides different instructions.
The surgeon may instruct caregivers to place a catheter through the opening a few times a day and stretch it in a specific way. This helps prevent the opening from closing prematurely. Follow the surgeon's instructions for how, when and how long to do this.
Care task | Key point |
Covering the opening | Use a diaper large enough to cover the opening and contain urine. |
Skin care | Keep the area clean and dry. |
Irritation | Rashes can occur; ask the care team whether an ointment is appropriate. |
Catheter use | Place the catheter only as instructed. |
Stretching | Follow the surgeon's directions about timing and technique. |
Clothing | A larger diaper may help keep clothes from becoming wet. |
What does the opening look like?
The vesicostomy opening looks like a small cut surrounded by light-pink tissue. Ask the child's healthcare professional what appearance is expected for that child and when a change should be reported.
What are the benefits of a vesicostomy?
The main benefit is that urine can drain from the child's bladder rather than building up. If urine backs up from the bladder toward the kidneys and urinary tract, it can contribute to urinary tract infections and kidney damage.
If an infection reaches the kidneys, possible consequences include kidney infection, kidney scarring, renal hypertension and kidney failure.
The child's healthcare professional may determine that vesicostomy is the best way to remove urine from the bladder and avoid the potentially damaging effects of urine accumulation.
Potential benefit | Why it matters |
Bladder drainage | Provides a route for urine to leave the bladder. |
Reduced back-up | May help prevent urine from moving backward toward the kidneys. |
Kidney protection | May help avoid kidney damage associated with urine accumulation or infection. |
Temporary support | Gives the care team time to determine long-term treatment. |
What are the risks and complications?
All procedures carry some chance of complications. The listed risks after vesicostomy are urinary tract infection, bladder prolapse and premature closure of the vesicostomy opening.
Bladder prolapse means that the bladder comes through the opening. A small part of the bladder may also appear when the child strains, such as during a bowel movement. If the bladder does not return after the child bears down, contact the child's healthcare professional.
If the opening begins to close before it should, the surgeon may need to open it again. Following instructions for stretching or widening the opening can help prevent premature closure.
Possible complication | What it means |
Urinary tract infection | An infection involving the urinary tract. |
Bladder prolapse | The bladder comes through the vesicostomy opening. |
Premature closure | The opening begins to close too soon and may need to be reopened. |
Skin irritation | Rashes and irritation around the opening are common during diaper care. |
Do not attempt to manage a new bulge, closure or other unexpected change using general online instructions. Contact the treating team for individualized guidance.
What is the outlook after vesicostomy?
Most children do very well after vesicostomy. Some need extra diaper-rash ointment because of skin irritation, and some need a larger diaper to cover the opening properly and keep clothes dry.
Caregivers may need time to become comfortable with diaper care, keeping the skin dry and following catheter-stretching instructions. The surgeon determines how long stretching should continue and when the opening can be closed.
If a small part of the bladder comes through the opening during straining and does not go back in, call the child's healthcare professional. If the opening starts to close too early, the surgeon may need to reopen it.
When should caregivers contact the healthcare professional?
Contact the child's healthcare professional if the child is recovering from vesicostomy and has signs that may indicate infection or another complication. Warning signs include high fever, redness and irritation around the incision, inability to insert a catheter, pain or discomfort that does not improve with medicine, and blood in the urine.
Warning sign | Action |
High fever | Contact the child's healthcare professional. |
Redness or irritation around the incision | Contact the child's healthcare professional. |
Inability to insert the catheter through the opening | Contact the child's healthcare professional. |
Pain or discomfort not improving with medicine | Contact the child's healthcare professional. |
Blood in the urine | Contact the child's healthcare professional. |
Bladder does not return after straining | Contact the child's healthcare professional. |
Opening begins to close too soon | Contact the surgeon or care team. |
If the child appears seriously unwell or symptoms are rapidly worsening, follow the emergency instructions provided by the treating team. This article cannot determine the cause or severity of a child's symptoms.
Questions to ask before surgery
A written question list can help caregivers understand the temporary opening, daily care and expected recovery. Ask the surgeon to demonstrate catheter placement and stretching rather than relying on written descriptions alone.
Topic | Example question |
Purpose | Why is vesicostomy being recommended for my child? |
Timing | How long might the opening be needed? |
Procedure | Where will the opening be located, and how long should surgery take? |
Anesthesia | What should we expect before and after general anesthesia? |
Catheter | How and when should we place the catheter? |
Stretching | How should we stretch the opening, and for how long? |
Diaper care | What size or style of diaper will cover the opening? |
Skin care | What should we do if the skin becomes red or irritated? |
Activity | When can my child return to daycare, school, running, biking or play? |
Pain | Which medicine is appropriate, and when should pain improve? |
Closure | What will determine when the opening is closed? |
Warning signs | Who should we call for fever, blood in the urine, pain or catheter difficulty? |
Conclusion: Understand the purpose, care routine and warning signs
A vesicostomy creates a temporary opening through the lower abdomen so urine can drain from a child's bladder when independent bladder emptying is not possible. The goal is to prevent urine from backing up toward the kidneys and urinary tract, where it can contribute to infection and kidney damage.
The procedure takes about one to two hours and is performed under general anesthesia. Afterward, many children go home the same day, although some stay overnight for monitoring. Caregivers may need to protect the opening, keep the skin clean and dry, use a large enough diaper and place a catheter or stretch the opening as instructed.
Ask the child's pediatric urology team to explain why vesicostomy is being considered, how long it may be needed, how to perform catheter stretching, what activities to avoid and when the opening may be closed. Contact the care team for high fever, incision redness or irritation, catheter difficulty, pain not improving with medicine, blood in the urine or a bladder bulge that does not return.
Frequently Asked Questions
What is a vesicostomy in a child?
It is a procedure that creates an opening from the bladder through the lower abdomen so urine can drain when a child cannot empty the bladder independently.
Where is the vesicostomy opening made?
It is usually made in the lower abdomen, just below the belly button.
Where does the urine go?
Urine drains directly into the child's diaper rather than a colostomy bag.
Is a vesicostomy permanent?
No. It is usually temporary while the healthcare team determines long-term treatment for the underlying bladder-emptying problem. The surgeon eventually closes the opening.
What conditions may be associated with a vesicostomy?
Medical references list spina bifida or neurogenic bladder, vesicoureteral reflux, spinal cord injury or a nervous-system disorder, bladder outlet obstruction, congenital urological anomalies, prune belly syndrome and recurring urinary tract infections.
What age do children usually have a vesicostomy?
There is no set age. Most children who receive one are younger than 5 years old, while older children and teenagers having one is uncommon but possible.
How long does the surgery take?
A vesicostomy takes about one to two hours.
Will my child feel pain during the procedure?
General anesthesia prevents pain during surgery. Some discomfort may occur as anesthesia wears off, and the care team explains which pain medicine to use.
Will my child stay in the hospital?
Many children go home several hours after recovering in the recovery room. Some stay overnight for monitoring.
How often should the catheter be placed?
The surgeon may instruct caregivers to place a catheter through the opening a few times a day so it does not close too soon. Follow the child's specific instructions for timing and technique.
Why does the opening need stretching?
Stretching instructions help prevent the vesicostomy opening from closing prematurely. The surgeon explains how and when to stretch it and how long to continue.
Can my child go to daycare or school?
Most children can resume daycare or school within about a week, but activities that could damage the opening should be avoided until the care team says they are safe.
Can my child run, ride a bike or roughhouse?
Wrestling, roughhousing, bike riding and running should be avoided during recovery. Ask the treating team when each activity can resume.
What are the main complications?
The listed complications are urinary tract infection, bladder prolapse and premature closure of the vesicostomy opening.
What if part of the bladder comes through the opening?
A small part of the bladder may appear when the child strains. If it does not go back in after the child bears down, contact the child's healthcare professional.
How do I prepare my child for a vesicostomy?
Tell your child's healthcare provider about every medicine your child takes and any known allergies. [1] The provider explains when your child must stop food and drink before surgery, including breast milk or formula, so follow those instructions exactly. [1]
When should I call the care team?
Call for high fever, redness or irritation around the incision, inability to insert the catheter, pain or discomfort not improving with medicine, blood in the urine, a bladder bulge that does not return or an opening that starts to close too soon.
Related guides
What Is Vesicoureteral Reflux? A Plain-Language Guide to the Urine-Backflow Condition in Children
What Is Bladder Outlet Obstruction? Causes, Symptoms, and Treatment Explained
Urinary Tract Infection (UTI): Symptoms, Causes, Treatment, and Prevention
Spinal Cord Injury Guide: Symptoms, Causes, Diagnosis, and Treatment
Understanding Prune Belly Syndrome: Symptoms, Causes, and Care
Anesthesia Essentials: A Guide to Types, Safety, and Recovery
References
Cleveland Clinic. Vesicostomy. Cleveland Clinic. Last updated January 31, 2024. https://my.clevelandclinic.org/health/procedures/vesicostomy
Morrisroe SN, O'Connor RC, Nanigian DK, et al. Vesicostomy revisited: the best treatment for the hostile bladder in myelodysplastic children? BJU Int. 2005;96(3):397-400. PMID 16042737. https://doi.org/10.1111/j.1464-410X.2005.05638.x
Kobayashi D, Hasegawa Y, Imai Y, et al. [Clinical outcomes of cutaneous vesicostomy in pediatric urological diseases]. Nihon Hinyokika Gakkai Zasshi. 2019;110(4):230-233. PMID 33087683. https://doi.org/10.5980/jpnjurol.110.230
Jeng G, Misseri R, King SJ, et al. Cutaneous vesicostomy: Effects on future bladder outcomes in patients with spina bifida. J Pediatr Urol. 2025;21(6):1700-1706. PMID 40846512. https://doi.org/10.1016/j.jpurol.2025.07.023
Disclaimer
This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional with any questions about a medical condition or treatment.
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