A Unique Method to Enhance Vesicostomy Pouching in a School Aged Child

Tim Luttrell, BSN, RN, CWOCN, Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN and Lisa Kirk, MSN, RN, CWOCN, Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, IN
A Unique Method to Enhance Vesicosotmy Pouching in a School Aged Child

Statement of Clinical Problem:    A Vesicostomy is a urinary diversion most commonly performed in infants and young children for temporary bladder drainage.   Diapers are typically used to manage the urine output.  When a child reaches school age, diapering is not an effective and acceptable way to contain the drainage and odor.   J is a 7 year old female with a history of Spina Bifida with neurogenic bowel and bladder. 

Description of Past Management:    Attempts were made to pouch the Vesicostomy but due to the anatomical location (just above the symphysis pubis and in a deep abdominal fold) and lack of a budded stoma, pouching has not been effective.  Diapers are being used to manage the drainage.  J attends school and struggles socially due to odor and leakage of urine.  Her mother reports changing and washing bed linen daily.  Frequent clothing changes throughout the day causes J to miss valuable classroom time.   

Current Clinical Approach:  After conferring with the Urologist, an AFM Ag dressing ribbon was tucked into the Vesicostomy to wick the urine flow into the ostomy appliance.  A flexible 2-piece Urostomy pouching system was used. 

Patient Outcomes:  The Veiscostomy tissue remains healthy, surrounding skin is intact.  Urine is clear with no odor.  The use of the AFM Ag ribbon has been effective at keeping the urine from pooling under the wafer.  There have been no UTI’s in the seven months since using this method to manage the urine. 

Conclusion:   Mom is having success with pouching the Vesicostomy since using the AFM Ag ribbon.  J is no longer waking up wet.   Laundry expenses and time have decreased substantially.   J has remained healthy and odor free.  She is thriving in school and no longer feels isolated from her friends.