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Cutaneous Vesicostomy

"Vesicostomy" literally means an opening into the bladder, but the term covers two clinically distinct categories that should be separated explicitly:[1][3]

CategoryStoma typeContinenceDrainage
Incontinent (cutaneous) vesicostomyOpen dome-to-skin stoma; no continence mechanismNoneFree drainage into a diaper or pad
Continent (catheterizable) vesicostomyCatheterizable channel with a continence mechanismYesClean intermittent catheterization

This page focuses on the incontinent form (Blocksom and Lapides) and indexes the continent alternatives, all of which are covered in their own dedicated pages.

For continent vesicostomy options, see:

Blocksom Vesicostomy​

The simplest tubeless cystocutaneous fistula, described by Blocksom in 1957 — the bladder dome is brought to the suprapubic skin and sutured directly to the skin edges, draining freely into a diaper or absorbent pad.[2][5]

Technique​

  • Small transverse or vertical suprapubic incision.
  • Bladder dome mobilized to the skin surface.
  • Bladder wall sutured directly to the skin edges as a flush stoma.
  • No tube or catheter required — gravity drainage into a diaper or pad.[2][5]

Indications​

  • Pediatric. Temporary urinary drainage in infants and young children with neurogenic bladder (spina bifida), posterior urethral valves, vesicoureteral reflux, or other congenital lower-tract anomalies — a bridge when reliable catheterization or definitive treatment is not feasible or has failed. CIC can be performed by caregivers in infancy; age alone is not an indication for diversion.[1][6][7]
  • Elderly / debilitated adults. Chronic urinary retention in patients with severe dementia, neurogenic bladder, or advanced prostate cancer who cannot manage catheters.[2][8]

Outcomes​

  • Snyder n = 48 (spina bifida, pediatric). Excellent temporary decompression with no loss of bladder volume while diverted; of 16 who underwent closure, 12 were continent on CIC.[6]
  • Tobu n = 16 (elderly, mean age 78.6 yr, mean follow-up 55.7 mo). Catheter-free in 87.5%; complications 37.5% (all within 2 yr); only 2 required reoperation.[2]
  • Fischer n = 67 (single institution, average duration 14.3 yr). Thirty-six retained vesicostomy; among these, 14 were satisfied, one unhappy, four deceased, and satisfaction was unknown for 17. Twenty-nine of 36 had spina bifida. Incomplete satisfaction ascertainment limits a broad “high satisfaction” claim.[9]

Complications​

  • Stomal stenosis 14.8–20%.[10][7]
  • Stomal prolapse — uncommon; may need revision.[11]
  • UTI 14.8%.[10]
  • Recurrent upper-tract calculi 33% in one series.[11]
  • Revision 7.4–20%.[10][7]

Lapides Vesicostomy​

A modification using a U-shaped bladder-wall flap brought to the skin, intended to provide durable drainage. The cited uncontrolled series does not prove less stenosis than Blocksom vesicostomy. The Di Benedetto pediatric series (n = 27) reported a revision rate of only 7.4%.[10]

Differences from Blocksom:

  • Uses a flap of bladder wall rather than direct dome-to-skin suturing.
  • Different flap configuration; comparative durability is not established.
  • Still incontinent — no continence mechanism.

Permanent vs Temporary Vesicostomy​

Although traditionally a temporary diversion, a substantial proportion of severely affected patients keep the vesicostomy for life:[9][11]

  • Hutcheson n = 23 (myelomeningocele) — permanent vesicostomy resolved hydronephrosis in all; described as "an acceptable alternative when continence is not realistic."[11]
  • Fischer reported 36/67 (53.7%) retaining vesicostomy at last follow-up; satisfaction was known in only 15 of these 36 patients.[9]

Bladder-Neck Closure + Continent Vesicostomy — the "Last Resort"​

When the bladder outlet is non-reconstructible (recurrent post-prostatectomy stricture with incontinence, post-vulvectomy, severe neurogenic outlet failure), the bladder neck is surgically closed and a continent vesicostomy becomes the sole drainage route.[21][22]

Spahn / Riedmiller n = 17​

Mean follow-up 68 months:[21]

  • Indications: recurrent anastomotic stricture + post-prostatectomy incontinence (59%), neurogenic bladder (35%), post-vulvectomy (6%).
  • Continent outlet: appendicovesicostomy (n = 8) or ileal-intussusception valve (n = 9).
  • Simultaneous ileocecal augmentation in 9 patients with reduced capacity.
  • Primary bladder-neck closure 100% successful.
  • Primary continence 82%.
  • 3 (18%) had continence failure (2 from reduced capacity, 1 iatrogenic) — all reconstructed successfully.
  • Stomal stenosis 23% (3/8 abdominal, 1/9 umbilical).
  • Stoma placed using the "butterfly technique" (8) or at the umbilicus (9).

Reid n = 24 (10 with bladder-neck closure)​

Closure successful in 8/10; CIC through abdominal stoma was "cleaner and more aesthetically pleasing"; a dry perineum reduces skin breakdown.[22]

Combined Bladder-Neck Reconstruction + Continent Stoma — bladder exstrophy​

Kasprenski n = 24 (exstrophy), median age 8.9 yr:[23]

  • 71% completely dry for ≥3-hour intervals.
  • 29% did not achieve continence; 60% of failures had subsequent bladder-neck transection.
  • Offers volitional voiding while maintaining a continent stoma as backup.

Benchekroun Hydraulic Ileal Valve (Historical)​

Described by Benchekroun in 1975 (Morocco): a 14 cm ileal segment intussuscepted into itself along its entire length functions as a hydraulic check valve on the inkwell principle — retrograde reservoir pressure collapses the inner tube, preventing efflux while permitting catheter passage.[14][18]

Outcomes​

  • Benchekroun original n = 136 (13 yr). 75% immediately continent; 93.4% continent after valve repair; self-catheterization easy in 88.3%.[14]
  • Quinlan / Leonard (Johns Hopkins) n = 15. All continent diurnally and nocturnally; revision 33% (vs 58% with plicated ileal efferents); described as their "continence mechanism of choice" at the time.[15][19]
  • Sanda / Gearhart n = 11 at 5 yr. Only 13% had complications at 18 months, but 91% required revision by 5 yr — stomal stenosis 73%, calculi 36%, devagination 36%; 64% needed major revision. Authors concluded that "novel forms of urinary diversion require extended follow-up for accurate assessment."[20]
  • Hanna pediatric experience. 4/5 children developed stomal stenosis, 1 had valve perforation; only 1 of 5 still doing well at 6 years; described as "disappointing"; recommended Monti or Nissen-valve alternatives.[13]
  • Guzman modification. Suture rather than staple stabilization of the inner tube; eliminated staples, reducing stone and fistula risk; all 7 continent at 6 mo–2 yr.[18]

Current status. Largely abandoned because of unacceptably high long-term stenosis and devagination rates; included here for historical and lineage completeness.[13][20]

Continence Mechanisms — At-a-Glance​

MechanismPrincipleChannels using it
Flap valve (submucosal tunnel)Channel runs along reservoir wall; rising pressure compresses channel against backing wallMitrofanoff (APV), Yang-Monti, TBF Casale/Rink
Intussusception nipple valveChannel telescoped into reservoir; pressure collapses nipple lumenHemi-Kock, Kock pouch, TBF Peard
Hydraulic collapse (inkwell)Intussuscepted ileal segment collapses under retrograde reservoir pressureBenchekroun valve (largely abandoned)
Rectus-muscle compressionChannel passes through crossed rectus strands; lateral pressure adds to closureTBF Yachia
Nissen fundoplicationReservoir wall wrapped around channel baseRichter / Hanna Nissen valve
Plicated ileocecal valve + tapered ileumNative valve reinforced; ileal peristalsis assistsIndiana pouch, IAC
Lich-Gregoir extravesical detrusor tunnelChannel embedded in detrusor trough; muscle compression provides continenceTBF Stief-Becker, extravesical implantation[24]

The Riley extravesical implantation experience (VanderBrink n = 84 of 394) reported 94% stomal continence with a 26% revision rate at mean 45 months (mostly skin-level or endoscopic), with the advantage of avoiding a large cystotomy.[24]

Stomal Stenosis — the Universal Challenge​

Across all continent vesicostomy techniques, stomal stenosis is the dominant complication.

  • Overall incidence 6–45% depending on technique and follow-up.[3][16][25]
  • One short-follow-up cohort saw many early problems, but complications continue throughout channel life. The 260-patient exstrophy series had median 1.9 years to stenosis, and other cohorts reported later events.[16]
  • Risk factors depend on cohort and technique. The 86% umbilical figure was 6/7 patients in a 31-patient TBF series, not all continent stomas. In Harris’s 260 classic-exstrophy cohort, multifilament suture was associated with stenosis; these observational findings do not establish a universal sex, stoma-site, or channel hierarchy.[3][26][25]
  • Etiology (Harris n = 260 exstrophy): scar contracture 63%, keloid 26%, hypertrophic scar 11%.[26]
  • Management: assess the level and cause of narrowing. Skin-level stents, dilation, local incision/rearrangement, or deeper revision may be appropriate. Reported 100% or 66.7% success figures are selected cohorts and definitions; seven L-stent users reported improvement, with concurrent topical therapy in most. An acutely uncatheterizable reservoir requires prompt urologic care.[26][27][4][16]

De Ganck's summary stands: "a high easy-to-treat complication rate is the price for a continent stoma." Despite a 36% complication rate, most were easy to treat and patient satisfaction stayed high.[25]

Other Channel Complications​

  • Stomal incontinence 2–6%.[12][28]
  • False passage 5–10% — most managed by catheter drainage.[17][16]
  • Channel stricture 6% — operative or endoscopic resection.[28]
  • Stomal prolapse 5% — usually late; operative revision.[28]
  • Channel leakage occurred in 6/67 patients in Welk; injection was attempted in four and succeeded in two. This very small denominator does not establish a dependable 50% cure rate.[28]
  • Recurrent UTI 12–36%.[25]
  • Bladder stones 6–10%.[25]

Welk noted that complications "appear to occur throughout the life of the channel," with some appearing years after construction — emphasizing the need for lifelong surveillance.[28]

Decision Algorithm — Which Vesicostomy​

Temporary urinary drainage (infants / children)

  1. Blocksom — simple, tubeless, reversible; ideal for infants with neurogenic bladder, PUV, or severe reflux as a bridge to CIC or reconstruction.[6][1][7]
  2. Lapides — wider stoma, may have lower stenosis rate.[10]

Permanent incontinent drainage (elderly / debilitated)

  1. Blocksom — useful in elderly patients with chronic retention and severe dementia who cannot manage catheters.[2][8]

Continent catheterizable stoma

  1. First choice: Appendicovesicostomy.[12]
  2. Appendix unavailable + adequate bladder capacity: Tubularized Bladder Flap.[17][3]
  3. Appendix unavailable + capacity marginal or augmentation needed: Yang-Monti (channel + augmentation patch from one pedicle).[3]
  4. Augmentation + continent stoma in adults (single bowel segment): IAC or Hemi-Kock.[21]
  5. Devastated bladder outlet: bladder-neck closure + continent vesicostomy (APV, ileal intussusception valve, or TBF) — see above.[21][22]

Special Populations​

  • Bladder exstrophy. Continent stoma creation is common after failed bladder-neck reconstruction. Largest exstrophy-specific series (Harris n = 260): stomal stenosis 25% at median 1.9 yr; monofilament umbilicoplasty suture was associated with less stenosis (p = 0.009).[26]
  • Myelomeningocele. Vesicostomy plays a central role across the lifespan — incontinent for safe infant decompression; timing of closure, CIC, or continent reconstruction is individualized; 6–10 years describes one historical cohort, not a prescribed age; some with severe disability retain permanent incontinent vesicostomy with high satisfaction.[6][11][9]
  • Adults with devastated outlet. Continent vesicostomy with bladder-neck closure is the "last resort" — primary continence ~82% with appropriate technique selection.[21]

See Also​

References​

1. Bruce RR, Gonzales ET. Cutaneous vesicostomy: a useful form of temporary diversion in children. J Urol. 1980;123(6):927–928. doi:10.1016/s0022-5347(17)56196-0

2. Tobu S, Noguchi M. Long-term outcomes of Blocksom vesicostomy for elderly patients with chronic urinary retention. Int J Urol. 2022;29(11):1357–1361. doi:10.1111/iju.14999

3. Cain MP, Rink RC, Yerkes EB, Kaefer M, Casale AJ. Long-term followup and outcome of continent catheterizable vesicostomy using the Rink modification. J Urol. 2002;168(6):2583–2585. doi:10.1016/S0022-5347(05)64221-8

4. Peard L, Fox PJ, Andrews WM, et al. Continent catheterizable vesicostomy: an alternative surgical modality for pediatric patients with large bladder capacity. Urology. 2016;93:217–222. doi:10.1016/j.urology.2016.03.018

5. McGrath M, Alnaqi AA, Braga LH. Vesicostomy and colostomy in a premature neonate with posterior urethral valves, bilateral dysplastic kidneys, and high imperforate anus: the challenge of stoma placement. Urology. 2016;93:191–193. doi:10.1016/j.urology.2016.02.031

6. Snyder HM, Kalichman MA, Charney E, Duckett JW. Vesicostomy for neurogenic bladder with spina bifida: followup. J Urol. 1983;130(4):724–726. doi:10.1016/s0022-5347(17)51424-x

7. Krahn CG, Johnson HW. Cutaneous vesicostomy in the young child: indications and results. Urology. 1993;41(6):558–563. doi:10.1016/0090-4295(93)90104-i

8. Tobu S, Noguchi M, Kurata S, et al. Usefulness of Blocksom vesicostomy in elderly men with chronic urinary retention and severe dementia. Geriatr Gerontol Int. 2015;15(8):997–1000. doi:10.1111/ggi.12381

9. Fischer KM, Bowen DK, Kovell RC, Canning DA, Weiss DA. Follow-up and outcomes of patients with long-term cutaneous vesicostomies at a single institution. Urology. 2020;144:255–260. doi:10.1016/j.urology.2020.04.130

10. Di Benedetto V, Bankole Sanni R, Miano L, Monfort G. Vesicostomy in childhood: indications and results. Pediatr Surg Int. 1996;11(5–6):348–350. doi:10.1007/BF00497809

11. Hutcheson JC, Cooper CS, Canning DA, Zderic SA, Snyder HM. The use of vesicostomy as permanent urinary diversion in the child with myelomeningocele. J Urol. 2001;166(6):2351–2353.

12. Cain MP, Casale AJ, King SJ, Rink RC. Appendicovesicostomy and newer alternatives for the Mitrofanoff procedure: results in the last 100 patients at Riley Children's Hospital. J Urol. 1999;162(5):1749–1752. doi:10.1016/s0022-5347(05)68230-4

13. Richter F, Stock JA, Hanna MK. Continent vesicostomy in the absence of the appendix: three methods in 16 children. Urology. 2002;60(2):329–334. doi:10.1016/s0090-4295(02)01735-1

14. Benchekroun A, Essakalli N, Faik M, et al. Continent urostomy with hydraulic ileal valve in 136 patients: 13 years of experience. J Urol. 1989;142(1):46–51. doi:10.1016/s0022-5347(17)38658-5

15. Quinlan DM, Leonard MP, Brendler CB, Gearhart JP, Jeffs RD. Use of the Benchekroun hydraulic valve as a catheterizable continence mechanism. J Urol. 1991;145(6):1151–1155. doi:10.1016/s0022-5347(17)38560-9

16. Thomas JC, Dietrich MS, Trusler L, et al. Continent catheterizable channels and the timing of their complications. J Urol. 2006;176(4 Pt 2):1816–1820; discussion 1820. doi:10.1016/S0022-5347(06)00610-0

17. Polm PD, de Kort LMO, de Jong TPVM, Dik P. Techniques used to create continent catheterizable channels: a comparison of long-term results in children. Urology. 2017;110:192–195. doi:10.1016/j.urology.2017.08.030

18. Guzman JM, Montes de Oca L, Gonzalez R, Ercole CJ. Modified Benchekroun technique for continent ileal stoma. J Urol. 1989;142(6):1431–1433. doi:10.1016/s0022-5347(17)39118-8

19. Leonard MP, Quinlan DM. The Benchekroun ileal valve. Urol Clin North Am. 1991;18(4):717–724.

20. Sanda MG, Jeffs RD, Gearhart JP. Evolution of outcomes with the ileal hydraulic valve continent diversion: reevaluation of the Benchekroun catheterizable stoma. World J Urol. 1996;14(2):108–111. doi:10.1007/BF00182567

21. Spahn M, Kocot A, Loeser A, Kneitz B, Riedmiller H. Last resort in devastated bladder outlet: bladder neck closure and continent vesicostomy — long-term results and comparison of different techniques. Urology. 2010;75(5):1185–1192. doi:10.1016/j.urology.2009.11.070

22. Reid R, Schneider K, Fruchtman B. Closure of the bladder neck in patients undergoing continent vesicostomy for urinary incontinence. J Urol. 1978;120(1):40–42. doi:10.1016/s0022-5347(17)57033-0

23. Kasprenski M, Benz K, Jayman J, et al. Combined bladder neck reconstruction and continent stoma creation as a suitable alternative for continence in bladder exstrophy: a preliminary report. Urology. 2018;119:133–136. doi:10.1016/j.urology.2018.05.009

24. VanderBrink BA, Kaefer M, Cain MP, et al. Extravesical implantation of a continent catheterizable channel. J Urol. 2011;185(6 Suppl):2572–2575. doi:10.1016/j.juro.2011.01.027

25. De Ganck J, Everaert K, Van Laecke E, Oosterlinck W, Hoebeke P. A high easy-to-treat complication rate is the price for a continent stoma. BJU Int. 2002;90(3):240–243. doi:10.1046/j.1464-410x.2002.02805.x

26. Harris TGW, Haffar A, Crigger CB, et al. Stomal stenosis after continent urinary diversion in bladder exstrophy: risk factors and management. Urology. 2024;191:110–118. doi:10.1016/j.urology.2024.07.003

27. Mickelson JJ, Yerkes EB, Meyer T, Kropp BP, Cheng EY. L stent for stomal stenosis in catheterizable channels. J Urol. 2009;182(4 Suppl):1786–1791. doi:10.1016/j.juro.2009.02.068

28. Welk BK, Afshar K, Rapoport D, MacNeily AE. Complications of the catheterizable channel following continent urinary diversion: their nature and timing. J Urol. 2008;180(4 Suppl):1856–1860. doi:10.1016/j.juro.2008.03.093