Urology Reconstruction: What Are the Options?

One of the reasons families come to the Center for Colorectal and Pelvic Reconstruction (CCPR) is the multi-disciplinary, collaborative approach to care to provide the best possible care to their child. Our team represents urology, gynecology, colorectal, psychology, social work, and child life. We often combine urology and colorectal surgeries to work on getting a child clean of poop accidents and dry of pee accidents at the same time. There are many ways to do this, and each approach is unique to the patient and family’s needs. Below we will explore some different surgical options that may be discussed for your child’s urologic needs.

Vesicostomy

This procedure is where the bladder is surgically brought to the belly and the patient pees through an opening (stoma) on their belly either into a diaper or a pad placed over the stoma. This is a safe option where the bladder is a low-pressure system and is great for protecting the kidneys.

Ileovesicostomy

This involves using a piece of bowel to create a tube that is connected to the bladder and brought to the belly to create a stoma. Because of how this stoma is fashioned on the outside of the belly, the ileovesicostomy can have a bag placed over it to catch the pee. This bag is emptied every few hours as it fills and is changed every few days. This allows the child to be dry, in regular underwear, while also keeping their urinary system very safe and in a low-pressure system. 

Mitrofanoff

Many children are not able to empty their bladders on their own. Instead, they have to use a tube to drain their pee from the bladder through their urethra (pee hole). This isn’t always doable for some children and families, so a channel that can be catheterized is considered. A mitrofanoff channel creates a tube out of the appendix which is then connected from the bladder to the belly button (or somewhere on the child’s belly). Typically, we choose to hide the channel in the belly button, so it is less noticeable. If a child does not have an appendix or the appendix has been used for another procedure, we then use a piece of bowel to create the channel connecting the bladder to the belly button or somewhere on the child’s belly. The family and child will be able to put a tube through the opening several times a day, drain the pee, and remove the tube until the next time they need to catheterize.

Bladder Augmentation

This surgery is when a piece of bowel is used to make the bladder bigger and increase the amount of pee the bladder can hold. Making the bladder bigger also makes the pressure inside of the bladder lower.

Bladder Outlet Repair

If the ring of muscle that holds pee in does not work correctly, the child may have what is called an open bladder neck. This may require a surgery to close or tighten these muscles in order for the child to remain dry of urine. Surgeries we can do to fix this include a bladder neck reconstruction, bladder neck sling, or an artificial urethral sphincter. We have to be very careful in our patient selection for these different options.

This information is only a small piece of the puzzle, but it can provide possible options for you and your child to discuss with your urologist. The timing of these procedures is very patient- and family- specific, and what works for one family may not work for another. The best thing is that even after the surgery your child can be a kid with any of these options. They can play, swim in a pond, and be a “normal” kid. Our job is to help you choose the option that works for your family while keeping your child healthy. Our team is looking forward to discussing these options in detail with you at your visit to our center.

For more information about the Center for Colorectal and Pelvic Reconstruction or to make an appointment, call (614) 722-4086 or visit the CCPR page.