A urostomy is a surgery that makes a permanent opening called a stoma. A stoma is a pathway from the bladder to the outside of your abdomen. This helps pee leave the body without passing through the bladder. Pee, or urine, is collected in a pouch worn on the outside of your body.
What is the bladder?
The bladder is a balloon-shaped organ in your lower abdomen that stores urine. Urine is filtered through your kidneys through tubes called ureters to the bladder. When you pee, your bladder muscles push the liquid out of your body through another tube called the urethra.
Why do I need a urostomy?
People with bladder cancer may have part of or all of their bladder removed as part of treatment. This is called a cystectomy. Without a bladder, the urine must be redirected using a urostomy. This is one of the most common surgeries in bladder cancer treatment. Sometimes women being treated for uterine or cervical cancer need a urostomy.
People with serious bladder issues caused by birth defects, surgery, or other injury may also need a urostomy. A urostomy is typically a permanent surgery and cannot be reversed.
Types of urostomy
There are 2 types of urostomy:
Standard or conventional urostomy. The surgeon removes a piece of the small intestine and uses it to connect the ureters and the outside of the abdomen. The urine then flows through this new path, called an ileal conduit, and out through the stoma. It is collected by an external pouch.
Continent urostomy. This procedure is the same as the standard urostomy, except the surgeon creates a pouch to hold urine. The pouch has valves on each end to keep the urine from flowing back into the kidneys and leaking through the stoma. You then insert a catheter several times a day into the stoma to drain the urine. There are several types of continent urostomies based on which part of the bowel the pouch is made from.
What should I expect during surgery?
You will receive general anesthesia before the surgery. The surgeon makes a small cut, called an incision, in the lower abdomen. He or she removes a 6- to 8-inch piece of the bottom of the small intestine and reattaches the small and large intestines together. This piece of intestine is then used to connect the ureter tubes and outside of the abdomen, based on the type of urostomy. The surgery lasts about 3 to 5 hours.
Surgery may include the following risks:
Problems with anesthesia
Bleeding or blood clots
Injury to other body parts or organs
Intestinal blockage caused by scar tissue
Bowel function changes
How long will it take to recover from surgery?
Most people stay in the hospital for up to 1 week after the procedure. You will not be able to eat solid foods and will be fed nutrients through a tube in your vein, or intravenously. Once you return home, you should limit your physical activity and avoid lifting heavy objects for about a month.
Emptying your urostomy bag. Once you have recovered from surgery, you will need to empty the urostomy bag several times per day. It is best to empty it when the bag is less than half full, usually every 2 to 3 hours.
Urostomy pouches come in many sizes and shapes, but there are 2 main types:
One-piece pouches attach directly to the skin barrier.
Two-piece pouches include a skin barrier and a pouch that can detach from the body.
Most pouches are drained through an opening at the bottom. They also prevent urine leaks and help contain odors. Ask your health care team about which type of urostomy pouch you will receive.
Draining urine with a catheter. If you have a continent urostomy, you will need to drain the pouch using a catheter several times a day. This frequency will decrease over time as the pouch slowly increases in size.
Caring for your skin. The skin surrounding the stoma is called peristomal skin. It will always look red and may bleed occasionally, which is normal. But bleeding should not continue for long.
It is important to make sure your pouch is correctly connected to your stoma. A pouch that does not fit well can irritate your skin. You should also keep this area clean and dry. If this skin appears wet, bumpy, itchy, or painful, contact your health care team because it may be infected.
Urinary tract infections. A urinary tract infection can happen when bacteria gets into the urostomy, ureters, or the kidneys. Make sure to wash your hands before and after emptying your pouch to avoid spreading bacteria. Also drink plenty of water every day and regularly empty your pouch. If you have dark or strong smelling urine, back pain near your kidneys, or fever, contact your doctor. These could be signs of an infection.
Urine pH balance. The pH of urine can be acidic or alkaline. After a urostomy, it is important to keep your urine acidic. Acidic urine is resistant to bacteria and helps prevent urinary tract infections. Drink plenty of non-alcoholic liquids every day to help keep your urine acidic.
When your urine is more alkaline, it can cause urinary crystals to form on your stoma. These crystals can irritate the stoma skin and cause bleeding. You can reduce these crystals by applying a vinegar compress to the stoma. Soak a clean cloth in equal parts water and vinegar and hold it on the stoma until the crystals decrease.