What Is a Urostomy? How Is the Surgery Performed, and How Is the Pouch Cared For?

A urostomy is an opening that a surgeon creates in the abdominal wall during surgery. It allows urine to drain directly out of the bladder. Bladder cancer or other problems affecting the bladder may make a urostomy necessary.

What Is a Urostomy?

A urostomy is an opening surgically created in the abdomen to drain urine. An opening called a stoma is generally used to remove urine. Surgeons create the stoma below or around the navel.

A urostomy stoma is moist and shiny, and round or oval. It has no nerve endings, so the stoma itself causes no pain or discomfort. Urine passes through the stoma onto the skin, making a pouch necessary to collect it.

The illustration below shows incontinent diversion (continuous urine flow collected outside the body), the most commonly used method of creating a urostomy.

Standard Urostomy

A standard or conventional urostomy, also called incontinent diversion, uses an ileal conduit (made from the small intestine) to collect urine. The ileal conduit is a pouch the surgeon creates from a small section of small intestine.

To create an ileal conduit, the surgeon:

1. Removes a 15–20 cm section of small intestine called the ileum.
2. Then connects the remaining ileum to the large intestine.
3. Detaches the ureters from the bladder and attaches them to the removed section of ileum.
4. Attaches one end of the ileal section to the front of the abdominal wall, creating a stoma.
5. Sews the other end closed to make a pouch that holds urine inside the body.
6. The patient will need to wear a collection pouch to collect urine.

The surgeon may or may not remove the bladder during this procedure, depending on the underlying condition.

Continent Diversion

Continent diversion, in which urine is stored in the body and emptied as needed, also involves creating a pouch. Unlike incontinent diversion, it has two valves. One prevents urine from flowing back to the kidneys; the other retains urine until the person inserts a catheter into the stoma to drain it.

The person needs to empty the pouch with a catheter (a small plastic tube) approximately four or five times a day.

There are different types of pouch:

• Kock pouch: The surgeon uses the end of the small intestine to create the pouch, valves and outlet.
• Indiana pouch: The surgeon makes the pouch from the large intestine and the outlet from the small intestine, using the ileocecal valve naturally present where the small intestine joins the colon.
• Mitrofanoff procedure: The surgeon makes the pouch from the bladder, large or small intestine, or a combination of these. The appendix, a fallopian tube or part of a ureter is used to create the outlet.
• Ileal neobladder: The surgeon creates a pouch from small intestine and connects it to the urethra so urine can leave the body normally. However, the person will need a schedule because they will not feel the urge to urinate.

Why Is a Urostomy Needed?

A person may need a urostomy if their bladder is damaged or surgically removed. Factors or conditions that may require a urostomy include:

• Bladder cancer: urostomy is most commonly needed because of bladder cancer surgery.
• Neurological dysfunction
• Congenital abnormality
• Chronic bladder inflammation

Other reasons for needing a urostomy include spinal cord injury and chronic bladder infection.

Some children may need a urostomy because a congenital abnormality causes a urinary tract problem in which urine flows back to the kidneys. Children born with spina bifida may also need one. In this condition, the spine and spinal cord do not develop properly, leaving the spinal cord exposed and unprotected.
Urostomy Surgery

Before the procedure, the person should follow all instructions from their doctor, surgeon or treatment team. They will provide specific preparation guidance, including when to stop eating and drinking, which medications to take and when, and where to go for surgery.

During Urostomy Surgery

On arrival, the surgical team begins preparations, including examining the abdomen to choose the best stoma location. Once the team is ready, the person receives general anesthesia before the doctor makes an incision and proceeds with surgery.

Recovery After Urostomy Surgery

During the hospital stay, the healthcare team demonstrates pouch changes and stoma care. Recovery continues at home after discharge. The stoma may take approximately 6-8 weeks to reach its final size. The person should discuss when to resume normal activities with their specialist.

How Is a Urostomy Pouch Cared For?

The healthcare team explains how to look after the pouch and stoma at home. They may give face-to-face instructions in hospital and send the person home with these instructions. These should be followed when caring for the stoma and pouch.

Emptying a Urostomy Pouch

In most cases, the pouch should be emptied when one-third to half full, which may be every 2-4 hours. Most stoma pastes that prevent leaks remain intact for 3-7 days. When they break down, a new pouch is needed.

Changing a Urostomy Pouch

The pouch itself needs changing every few days, depending on the brand. Some require daily changes, others every 3 days. Tape or a special belt can help hold it in place. The choice of method is personal.

Stoma Care

The stoma area can be protected by:

• Using the correct pouch size
• Changing the pouching system regularly
• Cleaning the skin with water and drying it
• Watching for sensitivity, irritation and allergies

Shaving the skin beneath the pouch may also be necessary to help the barrier adhere well.

Small blood spots need not cause alarm. The skin around the stoma can be sensitive, and cleaning it may irritate the stoma and cause minor bleeding. However, if bleeding does not stop quickly, the person should inform a doctor or stoma nurse.

Living With a Urostomy Pouch

Urostomy pouches should fit securely and discreetly under clothing. Several brands and designs are available, so a nurse or healthcare team member can help find the most suitable one. The pouching system should disrupt quality of life as little as possible.

Things to keep in mind when living with a urostomy pouch include:

• Work: Working life is generally unaffected unless heavy lifting or an exceptional circumstance is involved.
• Social and sexual life: People can maintain their usual social interactions, date, become pregnant and engage in sexual activity, provided the underlying condition does not make this inadvisable.
• Clothing: People can continue dressing as they did before surgery.
• Diet: Although specific diets do not make a difference, some experts recommend drinking 8-10 glasses of water daily to help prevent kidney problems.
• Sports and activities: People can shower with or without the pouch, travel without restriction and participate in most sports, but should be careful during close-contact sports.
• Sleep: A nighttime drainage system can collect more urine and allow uninterrupted sleep.

Get Support for a Stoma/Ostomy

Urostomy surgery is performed by urological surgeons. Your surgeon and urology team will be your main sources of support for stoma care.

In Turkey, the Association of Wound, Ostomy and Continence Nurses can help people find a wound, ostomy and continence nurse. A day in October each year is also celebrated as “World Ostomy Day” . Events marking the day allow people to meet others with ostomies and receive support. They are also important for raising awareness among the public and people with ostomies.

When to See a Doctor

People can consult a doctor for:

• Bleeding around the stoma that does not stop
• Signs of infection, such as urinary tract or skin infection
• Allergic reactions, such as a rash around the stoma
• Herniation of bowel contents through the stoma

There may be other reasons to see a doctor. Often, however, a nurse or another healthcare professional can answer questions and provide support.

Frequently Asked Questions (FAQ) About Urostomy

1. How does a urostomy differ from a ureterostomy?

A ureterostomy is a type of urostomy. The surgeon connects the ureter directly to the stoma without using an internal pouch or conduit as in other urostomy types.

2. How does a urostomy differ from a urethrostomy?

Both are surgical procedures to divert urine. In a urethrostomy, however, the surgeon creates an opening in the urethra, the urinary passage leading from the bladder.

3. How does a urostomy differ from a colostomy?

A urostomy allows urine to pass from a damaged or defective bladder or a new pouch made from intestine, while a colostomy involves stool passing through part of the colon. The surgeon separates part of the colon to divert stool past a damaged section and attaches an abdominal pouch to collect it.

Summary

A urostomy is a procedure in which a surgeon creates an abdominal stoma and diverts urine away from the bladder. Urine passes through the stoma into a urostomy pouch that can be emptied as needed. Recovery takes time, but people can resume normal activities afterward. They need to replace the system’s components regularly and care for the stoma. Those needing support can contact various organizations.