What Is Ileovesicostomy?
Ileovesicostomy helps urine (pee) drain from the bladder into a bag or pouch attached to the belly, without a catheter. During the operation, the surgeon will:
- Cut a small section of intestine out of the normal continuity of the intestine
- Reattach the two cut ends of the intestine to put it back in continuity
- Use the removed section as a tube to create a new tube or channel from the top of the bladder to the outside of the skin on the belly
This channel, also called an ileal chimney, allows urine to flow up and out of the bladder into a bag attached at the surface of the skin. The opening in the skin is called a stoma. Once the new channel is in place, the child won’t urinate normally anymore. Instead, urine will flow out through the stoma and into the pouch as needed.
You or your child will not need to catheterize every few hours to empty the bladder. The bag will need to stay on at all times. You and your child will receive training from a nurse to learn to empty the pouch and take care of the stoma.
There are two possible ways the surgery may be done:
- Open surgery – A small cut (a couple of centimeters wide) is made in the belly. The skin is pulled aside so the surgeon can see and work directly on the child. This is the only surgical technique used in many hospitals. However, Nationwide Children’s Hospital reserves open surgery only for patients who are not good candidates for minimally invasive surgery.
- Robotic surgery – Several tiny cuts (several millimeters wide) are made in the belly. The surgeon uses a computer to control the robotic arms, which move small tools underneath the skin to do the operation.
Ileovesicostomy is done to help stop incontinence, or to drain the bladder and protect the kidneys in a child who is not regularly catheterized. If a child (or adult) cannot control when they urinate, they can either allow the urine to leak into a diaper or they can use a catheter or have surgery to control urine draining.
Diapers can become socially uncomfortable for children as they age. The smell of urine and its impact on the skin and any wounds in the diaper area can lead to low quality of life. In most cases, children are given training that allows them to catheterize — to insert a small tube every few hours to drain urine that has stored up in the bladder. This means they can be dry in between catheter sessions and do not need diapers or a urine bag. Catheters can improve quality of life by removing the need for diapers, but they require a strict emptying schedule: every few hours, every single day.
Some children are unable to manage catheters or have repeated problems, such as bladder perforation (rupturing the bladder) or kidney infections. In other cases, a catheterization schedule is not feasible for caregivers. An ileovesicostomy may be offered as a way for these children to:
- Protect the kidneys and urinary tract from damage
- Stay dry and avoid diapers
- Eliminate the need to catheterize
- Independently manage urine without transfer to a toilet (for wheelchair users)
Ileovesicostomy can help children be self-sufficient. It is a low-risk surgical option for children who are not good candidates for catheters and who do not want to stay in diapers. The surgery is most common for people with:
- Spina bifida and myelomeningocele
- Renal failure or damaged kidneys from infections
- Prior bladder perforation
- Difficulty following a catheterization schedule or those who do not want to or cannot catheterize
- Wheelchairs
Ileovesicostomy is not an emergency surgery. You will schedule the operation in advance. A nurse from Nationwide Children’s will call 1-3 days before the operation to give instructions.
You will need to arrive a day before the surgery is scheduled so that your child can be put on a liquid diet. The diet will help clean out the bowels so that the intestinal tube can be used for the procedure and so that there is more room for the surgeon to work inside the belly. No matter what technique the surgeon uses, ileovesicostomy requires a stay of about 3-7 days at the hospital.
- Your child may be admitted a day before the surgery and put on a liquid diet to clean out the bowels. The child must stop eating and drinking by midnight the evening before the surgery.
- You will be visited by a stoma nurse who will help plan where the stoma (opening) will be placed on the belly in preparation for surgery.They will put a mark on your child to help identify the best location for the stoma.
- Early the next morning, your child will be put to sleep for the operation using medicine (general anesthesia).
- Your child will be given at least one dose of antibiotics through an IV (a needle and tube going into the arm). This will help lower the chance of infection at the site of the cuts.
- The surgery will last about 3-5 hours. A surgery nurse will come out from time to time to let you know how your child is doing.
- In the recovery room, your child will be checked for complications and given pain medicine. There will be at least one small tube in place to allow urine to drain into a bag after the surgery. This allows the new channel and stoma to heal. This tube is temporary but you will go home with it for several weeks.
- Your child will be on a liquid diet at the hospital. He or she will be allowed to start a regular diet and go home once the bowels start working (passing gas) again. In some children, this can take up to a week.
Your child’s catheter must stay in place for 3-4 weeks after the surgery. This allows the swelling to go down and the cuts to heal. You will have to return to the hospital for a nurse to remove the catheter. You will also receive training from a nurse to learn how to clean the stoma and change out the urine bag. The nurse will provide some initial supplies and set you up with resources for home shipping for supplies in the future.
About 1 month after the catheter comes out, your child will need a follow-up ultrasound to check for swelling in the kidneys. This will let the doctor know if the surgery worked to effectively drain your child’s urine. Your child will also need an ultrasound at least every year to keep checking kidney health.
You should also expect the following after ileovesicostomy:
- The skin is usually closed with internal, absorbable stitches and sometimes also skin glue (except for the stoma, which stays open). The stitches disappear on their own and don’t require any special removal or care.
- Your child can wash by sponge bath for a few days to a few weeks following the surgery depending on the surgeon’s preference. After that, showers are acceptable. Children with a stoma should not take a bath initially after surgery.
- The site of the cut and stoma may be sore for a few days or weeks.
- Gym class, strenuous activity and heavy lifting should be avoided until the catheter is removed.
- Wheelchair transfers can begin again about 2 weeks after the operation.
You should call the doctor or seek medical attention for your child after ileovesicostomy if your child:
- Has a fever of 101°F or higher before the first follow-up visit
- Cannot pass urine through the catheter
- Accidentally pulls the catheter out
- Complains of severe pain in the belly, side or back that isn’t helped by the pain medicine they are given at discharge
- Has symptoms of a urinary tract infection (UTI) or kidney infection.
Ileovesicostomy can help keep patients dry, avoid the hassle and smell of diapers, and prevent skin and wound irritation. It is a low-effort, simple alternative to catheterization that doesn’t require frequent emptying or strict schedules. When done to replace a catheter solution due to problems with infection or bladder perforation, an ileovesicostomy can also help avoid those problems in the future.
In addition, the surgery has an excellent success rate with a lower likelihood of needing additional operations than other surgeries that make a drain for urine.
In general, the risks of ileovesicostomy include those of any surgery, such as infection, redness, swelling, bleeding, or failure of the operation. During surgery on the bladder, urine can also leak into other areas and cause some irritation.
Rarely, the place where the new tube is made forms a blockage that stops urine from getting out. In these cases, a catheter may need to stay in the new tube to help urine pass from the bladder to the urine bag. People may also continue to have some urine leaking from their urethra (the tube that people normally pee from). In addition, if your child gains a lot of weight in the future, this may also affect how well the tube drains and another operation may be required.
Since ileovesicostomy also requires surgery on the bowel, there is the risk that there will be a bowel blockage or leak soon after surgery. This problem is usually short-lived.
- Why do you recommend ileovesicostomy?
- What are the alternatives to this surgery?
- What are the pros and cons of ileovesicostomy versus intermittent catheterization?
- What would happen without this surgery?
- What are the long-term consequences of choosing this continence solution?
- What is life like with an ostomy bag?
- Are there other patients or families who might be willing to speak about their experience with ileovesicostomy?
- What surgical techniques are available?
At Nationwide Children’s, our goal is to get your child the help they need with the shortest possible recovery time. That’s why we offer minimally invasive surgery for ileovesicostomies. Although we do perform open surgery when needed, robot-assisted ileovesicostomy can help decrease pain, shorten hospital stays, speed recovery, and leave your child with less noticeable scars.
If an ileovesicostomy is the right option for managing your child’s continence needs, talk to our surgeons about minimally invasive surgery. We will evaluate your child’s health needs to find out if your child is a good candidate for our robot-assisted surgical technique.
