Urostomy

Overview

Urostomy surgery is a type of urinary diversion used after a cystectomy (bladder removal) to manage urine flow. This procedure involves creating a stoma to provide an alternative route for urine to exit the body.

Ostomy surgeries in general create an opening (stoma) in the abdomen to allow for the diversion of waste, which can include urine or stool. The three main types of ostomies are ileostomy, urostomy, and colostomy. For a urostomy, the stoma is connected to a section of the urinary tract to enable urine drainage into a pouch or ostomy bag.

Types of urostomies

There are several types of urostomies, such as ileal conduit, colonic conduit, and continent urostomy. These procedures are often named based on the method used to create the urinary diversion.

Ileal conduit

One type of urostomy is the ileal conduit. In this procedure, your surgeon uses a section of your small intestine to create a tube that connects to the stoma. The ureters, which transport urine from your kidneys, are attached to this new tube. Urine then travels through the tube to the stoma and exits your body.

Colonic conduit

This type of urostomy is similar to an ileal conduit, but instead of using a section of the small intestine, your surgeon will use tissue from the sigmoid colon to form the tube.

Continent urostomy

In certain cases, your surgeon might construct a new bladder or reservoir using intestinal tissue, known as a continent urostomy. This reservoir is connected to the stoma and can be drained through a plastic tube.

Examples of continent urostomies include:

• The Kock pouch: This procedure involves using the end of your small intestine to create the pouch, valves, and outlet.
• The Indiana pouch: This technique uses tissue from your large intestine to form the pouch and tissue from your small intestine for the outlet. The valve is made from the natural ileocecal valve, located where the small and large intestines connect.
• The Mitrofanoff procedure: This procedure can vary, as your surgeon may use tissue from your bladder, small intestine, colon, or a combination of these to create the pouch. The outlet can be created from the appendix, a fallopian tube, or a section of the ureter.

If you have a neobladder, a form of continent urinary diversion that creates a new bladder from intestinal tissue, you won’t need a stoma. Your surgeon will connect the neobladder to your urethra, allowing urine to exit your body as it did before. Since you won’t have the sensation of needing to urinate, you’ll need to set regular times to empty the neobladder.

Reasons for undergoing the procedure

A urostomy may be recommended by your doctor if your bladder has been damaged due to trauma or disease, or if it has been removed, as in cases of bladder cancer. It can also be suggested if your bladder is not functioning properly. For some people, a urostomy offers a preferable alternative to managing urinary incontinence, which is characterized by a lack of control over urination.

Additionally, a urostomy can be suitable for individuals with spinal cord injuries, congenital conditions like spina bifida, or damaged urethras. Infants born with urinary tract abnormalities that prevent effective urination, leading to urine backup and infections, may also undergo urostomy surgery.

Risks

A urostomy operation is generally quite safe. But hazards associated with any kind of surgery include:

• Blood clots or bleeding
• Anesthesia side effects
• Organ damage
• Infection
• Pneumonia

Subsequent issues can consist of:

• Blockages
• Irritation of the skin
• Stoma bleeding

Before the procedure

Before your surgery, your healthcare team, including your surgeon, will discuss the procedure with you to ensure you understand:

• The rationale for a urostomy.
• The steps involved during urostomy surgery.
• What can be expected from the urostomy procedure.
• The potential risks associated with the urostomy.

You will receive detailed instructions from your team regarding what to eat and drink the night before surgery as well as whether or not to take your regular medications. Make sure you disclose to your team all of the medications and supplements you are using.

Before the procedure, you’ll visit with your doctor to locate a good place for the stoma. It should be a level area that is simple for you to access.

During the procedure

During urostomy surgery, general anesthesia is used, so you won’t feel any pain. Depending on your condition, the surgery might also involve the removal of part or all of your bladder.

In cases where cancer is a factor, the surgeon may need to remove additional organs, such as the appendix, lymph nodes, or parts of the reproductive system. The specific details of the procedure will vary. For instance, if a neobladder is being created, a stoma will not be necessary.

For other procedures, the surgeon will create a stoma in your abdomen at a predetermined location. They will then connect the ureters to the tube leading to the stoma. The entire surgery can take up to six hours.

After the procedure

Following your surgery, you’ll be taken to a recovery unit before moving to a hospital room. You may have one or more drains to manage fluids, and you’ll receive medication to manage your pain.

Your healthcare team will assist you in beginning to move around after your surgery. Activities like sitting up, moving your legs, and walking are important for preventing blood clots and pneumonia.

A few days after the surgery, you should be able to resume drinking and eating normally. Your diet might include foods that aid in preventing constipation.

After a urostomy procedure, you will stay in the hospital for a period of time. Some patients are discharged after three days, while others may remain for up to seven days. During your hospital stay, you’ll be trained in stoma care and how to use the required ostomy supplies.

Outcome

You will need to take a break from work or school for about two months after leaving the hospital. During this time, you can focus on becoming more comfortable with caring for your urostomy.