Urostomy

Approved by the Cancer.Net Editorial Board, 10/2021

A urostomy is a surgery that allows urine (pee) to leave your body without going through your bladder. The surgery creates an opening called a stoma. The urine goes into a pouch (bag) you wear on the outside of your body.

What is the bladder?

The bladder is a hollow, balloon-shaped organ in your lower abdomen that stores urine. Urine normally flows into your bladder from the kidneys through small tubes called the ureters. Then when you pee, the muscles of your bladder push the liquid out of your body through another tube called the urethra.

Bladder Anatomy

Why do I need a urostomy?

There are different reasons that people may need a urostomy as part of their cancer care. Some of the most common reasons include:

People with bladder cancer may need part or all of their bladder removed. A urostomy helps urine leave the body if this is necessary. It is one of the most common surgeries in bladder cancer treatment.

People with cervical, uterine, or prostate cancer may need a urostomy if their urethra is damaged due to cancer or cancer treatment.

Other reasons for a urostomy include bladder problems from birth defects, other types of surgery, or an injury.

What are the different kinds of urostomy?

There are 2 types of urostomy:

Standard or conventional urostomy. This is also called an incontinent diversion. The surgeon uses a piece of your small intestine to connect the ureters to the outside of your body instead of the bladder. The urine then flows out through the stoma, where a pouch collects it.

Continent urostomy. This procedure is the same as a standard urostomy, except the surgeon creates a pouch inside your body to hold the urine. It is designed to keep urine from flowing backward to the kidneys or leaking out through the stoma. You empty this pouch several times each day using a small tube called a catheter.

A urostomy is usually a permanent surgery and cannot be reversed.

What should I expect during surgery?

You will have general anesthesia before the surgery. Anesthesia is medicine that keeps you from feeling pain. The surgeon makes a small cut, called an incision, in the lower abdomen. Then they remove a piece of the small intestine and use it to connect the kidneys to the outside of the body instead of to the bladder.

Surgery takes 3 to 5 hours. It can include the following risks:

Problems with anesthesia
Infection
Bleeding or blood clots
Injury to other body parts or organs
A block in the small intestine, caused by scar tissue
Changes in bowel function

How long will it take to recover after a urostomy?

Most people stay in the hospital for up to 1 week after a urostomy. Once you go home, you should limit your physical activity and avoid lifting heavy objects for about a month. Talk with your surgical team about specific recovery instructions for you.

How to care for your urostomy at home

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 you can take off.

Most pouches drain through an opening at the bottom. They also prevent urine leaks and help contain odors. Ask your health care team 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 small tube called a catheter several times a day. You can do this less often over time because the pouch will get larger.

Caring for your skin. The skin around the stoma will always look red. It might bleed now and then, and this is normal. However, call your doctor if the bleeding continues for more than a few minutes.

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 looks wet, bumpy, itchy, or painful, contact your health care team since these can be signs of an infection.

What to watch for when you have a urostomy

Urinary tract infections (UTIs). You can get an infection if bacteria get into the urostomy, ureters, or kidneys. Make sure to wash your hands before and after emptying your pouch to avoid this. Also, drink plenty of water every day and regularly empty your pouch.

Signs of a UTI include dark or strong-smelling urine, back pain near your kidneys, or fever. Call your doctor if you notice any of these signs.

Urine pH balance. Liquids, including urine, can be more acid or more alkaline. The acidity of urine fluctuates throughout the day. After a urostomy, it is important to keep your urine acidic. This means a pH level below 7. This resists bacteria and helps prevent urinary tract infections.

To keep your urine acidic, you can drink plenty of non-alcoholic liquids every day. Instead of drinking citrus juices, which can make your urine more alkaline, you can drink cranberry juice. You can also talk to your health care team about whether it is recommended to take vitamin C daily.

When your urine is more alkaline, above 7, crystals can 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. Your health care team will also provide you with guidance on how to regularly care for your urostomy and answers to common questions. Be sure to ask them about any concerns or questions you may have, too.