Urostomy

A urostomy is a medical procedure that surgically directs urine away from the bladder if the bladder or the urethra (the tube that lets urine leave the body) becomes damaged or diseased. After a urostomy, urine leaves the body via a stoma, an opening located in the abdominal region, and is collected in a pouch.

Here’s what patients and their families need to know about the urostomy procedure.

Why a urostomy is performed

A urostomy may be performed for several reasons. The most common reasons are cancer in or near the bladder or urethra, or damage to the bladder or urethra due to cancer or cancer treatment. A urostomy is one of the most common treatment options for bladder cancer. Others associated with a urostomy may include:

• Prostate cancer
• Cervical cancer
• Uterine cancer
• Colorectal cancer

A urostomy may also be done after injuries to the bladder or damage caused by surgery or birth defects.

Types of urostomy

Several types of urostomy procedures are available for patients and their doctors to consider when making treatment decisions. The two main categories use different methods to route urine out of the body instead of through the bladder. They are known as incontinent diversion and continent diversion.

Incontinent diversion: Also known as standard or conventional urostomy, in this procedure a small tube is made from part of the small intestine called the ileum. It’s connected to the ureters (thin tubular structures that connect the kidneys to the bladder), creating an transit tube called an ileal conduit. The patient must always wear a collection pouch after the surgery.

Continent diversion: This differs from the incontinent diversion in that external bags to collect urine are not necessary.

A continent diversion procedure may rely on one of several different types of internal pouch systems. These include the four types listed below.

Indiana pouch: The pouch is formed with part of the large intestine, and the outlet is made from the small intestine. The natural ileocecal valve is used as the control valve. Patients catheterize a small stoma on the abdomen several times a day to empty this pouch.

Kock pouch: The small intestine is used for the pouch, valves and outlet.

Ileal neobladder: The pouch is made from the small intestine. A stoma on the abdomen isn’t necessary with this type, as the urine passes through the urethra.

Mitrofanoff procedure: The pouch is made from either the large or small intestine or bladder. The outlet is constructed from one of the ureters, a fallopian tube or the appendix.

How to prepare for a urostomy

Before a urostomy, a patient’s health care team explains what to expect and how to prepare, including any dietary and medication changes. At this time, the stoma’s location on the abdomen is determined in a way that supports the patient’s comfort and lifestyle.

The urostomy is performed under general anesthesia and takes about one to three hours.

What to expect after a urostomy

Patients may spend up to a week in the hospital after a urostomy. Before going home, patients receive clear aftercare guidelines. These include limiting exercise and heavy lifting for about six weeks or until a doctor says it's safe to return to normal activities.

How to care for a urostomy

Patients are educated on ostomy care and how to empty their bag/pouch. The stoma and surrounding skin are delicate and require the following precautions:

• Wash the skin each time before attaching the urostomy bag.
• Avoid skin care products that contain oil and/or alcohol. Specific skin care products may be recommended.
• Use the proper sized bag to avoid urine leakage.

In general, a urostomy bag needs to be emptied several times per day, usually through a drain at the bottom. Patients with a continent urostomy drain the pouch with a catheter.

If patients notice any changes in the odor, color or size of the stoma—or experience any itching, redness or pus—it’s important to seek medical advice right away.

It may take some time to get used to living with a stoma, but a patient’s medical team may help by answering questions. There are also support networks where urostomy patients may connect with one another and share helpful information.

Urostomy complications and common problems

A urostomy is a common and safe medical procedure, but any surgery has a risk of complications. The risks associated with urostomy may include:

• Infection
• Blood clots or bleeding from the wound
• Changes to normal bowel functions
• Small intestine blockage due to scar tissue
• Injury or damage to other organs in the body
• Complications from anesthesia

Patients with a urostomy may be more prone to urinary tract infections (UTIs) if bacteria enter the body or the urostomy site. To help prevent this, patients should wash their hands before and after handling their pouch.

Maintaining the appropriate pH balance in the body may also prevent bacteria from forming. Post-urostomy patients are advised to keep their urine acidic with a pH below 7. This may be accomplished by drinking cranberry juice and avoiding citrus juices. Some patients may also benefit from vitamin C supplements.

Patients should contact their doctor if they notice any UTI symptoms, including:

• Dark urine
• Urine with an abnormal odor
• Fever
• Back pain near the kidneys