Ureterostomy

Overview

A ureterostomy is a surgical procedure that redirects the ureters—the tubes that carry urine from the kidneys to the bladder—to a new opening in the skin called a stoma. This allows urine to leave the body without passing through the bladder. The surgery can be done on one ureter (unilateral) or both (bilateral).

In a normal system, the bladder stores urine until it is expelled. After a ureterostomy, urine flows directly from the kidneys into an external pouch attached to the body, bypassing the bladder entirely. This pouch needs to be emptied as often as you would normally urinate. For children, urine may drain into a diaper.

A ureterostomy is typically performed when the bladder is either removed or unable to function properly due to injury, disease, or other conditions. Without this procedure, urine can accumulate, leading to chronic urinary tract infections (UTIs), kidney failure, and other serious health issues. In most cases, this surgery is intended to be a permanent solution.

Ureterostomy falls under the category of urinary diversion surgeries, which involve redirecting the flow of urine. Any surgery that creates a new opening in the skin for waste to exit the body is known as an ostomy.

Reasons for undergoing the procedure

Your doctor might suggest a ureterostomy if your bladder is unable to expel urine properly. Some possible reasons for this include:

• Because of damage or injury, your bladder no longer functions correctly.
• You underwent bladder removal (caused by illness or cancer).
• Congenital anomalies, such as spina bifida, are conditions present at birth.
• Damage to the spinal cord.

Risks

Every procedure has some risk involved. Before surgery, you should talk through the risks with your doctor. A few ureterostomy concerns include:

• Bleeding.
• Infection.
• Skin irritation, redness, swelling, or others.
• Hernia.
• The process is ineffective in solving the issue.
• Formation of scar tissue.

Before the procedure

Prior to a ureterostomy, the following examinations are typical:

• Kidney function tests: Assess how well your kidneys are performing.
• Blood tests: Evaluate various aspects of your health.
• Imaging tests: Such as X-rays or ultrasounds, to visualize internal structures.
• Retrograde pyelogram: Similar to an Intravenous Pyelogram (IVP), but the dye is inserted through the urethra instead of a vein.
• Computed Tomography (CT) scan: A specialized imaging method that uses a computer to compile multiple X-ray images into a detailed cross-sectional view.
• Magnetic Resonance Imaging (MRI): Uses magnetic fields and radio waves to produce high-resolution images of the kidneys and ureters.

Before surgery, you will have a consultation with a doctor to go over how to take care of your stoma. They will choose a spot for the stoma that is both easily visible and won’t obstruct your skin fold or belt line.

During the procedure

In a ureterostomy procedure, a surgeon separates one or both ureters from the bladder and connects them to an artificial opening in your skin called a stoma. This stoma, which can be up to 3 inches wide, serves as an exit for waste to leave your body.

Your bladder is no longer involved in the urinary process, so there is no place for urine to collect before it exits your body. Instead, it is expelled through a stoma into a plastic pouch attached to the outside of your body.

If you have a unilateral ureterostomy, this is not the case. In this instance, urine exits the stoma but urine from one ureter continues to accumulate in your bladder.

Your stoma cannot regulate the flow of urine because it lacks a sphincter, a muscle that opens and closes it. The following is how your new urinary system will function:

• The pouch is positioned outside the stoma to collect urine from your body.  
• The pouching system consists of two parts: a barrier and a collecting pouch. These parts can be combined into a single unit. The barrier is a square piece with a hole in the center that fits around the stoma and adheres to your skin. The adhesive on the barrier is strong enough to prevent any urine from leaking out of the pouch.  
• The collecting pouch attaches to the barrier and collects urine as it exits your body.  

People generally empty the pouch with the same frequency as they previously used the bathroom, typically when the pouch is one-third to half full. A valve at the bottom allows the urine to be emptied into a toilet without removing the pouch from the stoma.  

• At night, you can connect a flexible tube to the valve on the pouch, allowing urine to flow into a larger container while you sleep.  
• Pouches lie flat against your body and are securely attached to the skin. They are discreet and can be covered by clothing, making them unnoticeable to others.  

After the procedure

Your doctor will provide detailed instructions on how to clean and care for your stoma, the surrounding skin, and the pouch following your ureterostomy. You will also be taught how and when to change the pouch.

After the surgery, you should limit activities such as driving and heavy lifting for the first four to six weeks to allow the wound to heal properly. Once healed, you can usually return to your regular activities, including swimming and other water sports. However, your doctor might advise you to avoid high-impact sports like karate or football.

You will learn from your doctor how to take care of a stoma and how to change the pouch on a regular basis. Maintaining the stoma’s cleanliness and dryness is crucial. Each day, you ought to:

• Clean the stoma and the skin around it using mild soap and water.
• Rinse the area thoroughly.
• Ensure the stoma is completely dry before applying the new pouch.
• Replace the pouch every five to seven days. Discard the old pouch and attach a new one.

Outcome

When the bladder isn’t functioning properly, a ureterostomy helps to drain urine directly through the ureters. This reduces the risk of kidney damage or failure and helps prevent urinary infections.