Urostomy

Urostomy is a surgical procedure that aims to create an opening (stoma) in your abdominal wall (belly). This surgery is needed to help expel urine when your bladder is not able to do so, such as in the case of a diseased/damage/injury of the bladder or for some other condition that may cause your bladder to dysfunction. 

The surgery may also involve the removal of the bladder (cystectomy). 

Our urinary system comprises a pair of kidneys and ureters (two muscular tubes that pass out urine from the kidneys), as well as a bladder and urethra. The urine flows through the kidneys and reaches the bladder via the ureter. The bladder stores the urine until it leaves the body via the urethra. 

In urostomy, the urine bypasses your bladder and flows through an opening in the belly known as stoma. The stoma is pinkish-red in colour with a moist and shiny appearance. It may have a round or oval shape and may contract with time after the surgery.

There are two types of urostomy procedures:

• Incontinent diversion or conventional urostomy: This procedure involves the creation of an ileal conduit, which is a small opening created from a small portion of the small intestines for retaining urine. You will have to wear a pouch to collect urine outside your body. 
• Continent diversion: This type of surgery involves the creation of an internal pouch. The pouch consists of valves to prevent the backflow of the urine to the kidneys and to keep the urine in the pouch. A thin, flexible tube – catheter – is used to drain the urine from the pouch.

Your healthcare practitioner will recommend this surgery if you have:

• Bladder cancer 
• Injuries in the spinal cord 
• Spina Bifida (a birth defect occurring due to the improper formation of the spine and spinal cord)
• Birth defect in the urinary system that causes urine to flow back to the kidneys

Any bladder problem typically has incontinence, that is, the inability to control the flow of urine. Bladder cancer may also show the following symptoms:

• Blood while passing urine 
• Strong impulse for urination
• Burning sensation while urinating 
• Swollen legs 
• Involuntary loss of weight
• Pain in bones

A continent urostomy procedure is avoided in people with the following conditions:

• Persistent diarrhoea and malabsorption 
• Decreased functions of kidney and liver 
• Psychiatric conditions
• Neurological problems 
• Short life expectancy

Before performing this surgery, the following preparations are required:

• Diagnostic tests: Your healthcare practitioner will do a physical examination and instruct you to undergo the following tests before the surgery:

  • Urine test (to check for disorders of the urinary system)
  • Blood tests (to determine your fitness)
  • Chest x-ray (to check the internal organs in the chest)
  • Electrocardiogram (to check the proper functioning of the heart via the electrical activity of heart)
  • Cystoscopy (a procedure of endoscopy for bladder) 
  • Urography (examination of the urinary system)
  • Magnetic resonance imaging or computed tomography scans (to get more information about the underlying condition)
• Medicines: 
  • Tell your doctor if you take any medicine (previous or current) that you take, e.g., over-the-counter, minerals, vitamins, dietary supplements and home remedies. 
  • Information about the use of blood-thinning medicines like warfarin, aspirin or heparin should be conveyed to the doctor. 
  • You will need to stop the use of vitamin E supplements a few days before the surgery. 
  • Your doctor may give you certain medicines that are to be taken with some water on the day of your surgery. 
• Food and drinks: 
  • You will not be permitted to eat or drink anything from the midnight till the completion of surgery (until you are deemed fit).
• Lifestyle:
  • Your healthcare practitioner may ask you to stop alcohol consumption or smoking for a few days before the surgery. 
  • If you have a problem of sleep apnoea (a disorder in which a person is unable to breathe for a short interval of time in his/her sleep), then your doctor should know about the same.
  • Tell your doctor if you have allergies towards latex, medicine or any material should be provided to the doctor. 
  • If you are using heart implants like a pacemaker or automatic implantable cardioverter-defibrillator, you must apprise your doctor about the same. 
• Driving:
  • You will need someone (close relative or friend) who will drive you home after the surgery.

Your healthcare practitioner will perform the following steps for this surgery:

• You will be administered general anaesthesia that will make you unconscious during the surgery. 
• Then, the surgeon will make a cut in your belly.

• For an ileal conduit: 

  • The surgeon will cut out a small piece (6-8 inches long) of the lower portion of your small intestine (ileum) from near the junction between the small and large intestine. The rest of the ileum will be connected back to the large intestine. 
  • He/she will detach your ureters from your bladder and connect them to the piece of ileum that was cut out. 
  • One end of this piece of ileum will be made into a stoma (opening) by bringing it out through the front of your abdomen. The other end will be sewn into a pouch and placed in your abdomen to hold the urine.
  • You will need to wear a pouch that collects urine all the time.
• For continent diversion:
  • In this procedure too, the surgeon will make a pouch from your intestine and then attache your ureters to it. 
  • He/she will connect the pouch to the outside of your belly through a small opening called a stoma. The stoma is usually made under the navel (belly button).
  • The pouch created in this type of surgery has valves on both sides, one to keep the urine from going back towards the kidneys via the ureters and the other to stop the urine from draining out through the stoma. 
  • You will need to drain the urine from the pouch with a catheter multiple times a day.

The surgeon will close the incisions (cuts) with the help of stitches and bandage.

The urostomy procedure takes about two to five hours.

Based on your condition, the hospital stays usually lasts for three to four days after surgery.

Post-surgery, you will be asked to take a walk from time to time to prevent the risk of blood clots. You will be given nutrition via an intravenous line. The healthcare provider will teach you the timely replacement of the bag in ileal conduit, the use of the catheter and steps for taking proper care of the stoma.

Once you return home, you will need the following care:

• Medicines:

  • You will be given medicines that will help you manage the pain. 
  • Avoid driving or alcohol drinking while you are taking pain medicines. 
  • You may experience constipation due to pain killers. To relieve that, the doctor may prescribe medicines like docusate sodium or senna.
• Diet:
  • There are no eating restrictions after this surgery. However, if you have kidney damage, your healthcare practitioner may instruct you to check your protein and salt intake. 
  • Your urine pH (measure to check if the urine is acidic or basic) would be checked after the surgery. You should keep your urine acidic unless advised by your doctor. To keep the urine in the acidic state, you can drink cranberry juice and include cheese, eggs, fish, prunes, corn and poultry in your diet. 
  • It is highly recommended that you drink plenty of fluids.
• Emptying the pouch:
  • It is important to empty the pouch on time (before it is completely filled) to decrease the risk of infection.
  • To empty the pouch, sit as far as possible on the back of your toilet seat. 
  • Keep a toilet paper strip in the toilet to prevent splashing. 
  • Grip the bottom of your pouch and unlock the valve to slowly release the urine from the pouch. 
  • Tighten the valve and remove/dry out any wetness at the end of the valve with a toilet paper. 
  • During the day, some people may need to empty the pouch every two to four hours. 
  • At night, you can use an adjustable tube to drain your pouch. 
• Bathing:
  • You can shower or bath even with your pouch. 
  • Avoid using soap while cleaning the skin around the stoma. 
  • Bath oil should not be used around the stoma 
  • If you shower without your pouch, kindly ensure that you cool and dry your skin before replacing the pouch. 
• Shaving hair around the stoma:
  • If you have too many hair around the stoma, it will hamper the glueing of the pouch to the belly. This may cause pain while removing it. Hence, it is essential to trim or shave the hair around the stoma. 
  • Do not apply cream, lotion or soap while shaving. 
  • After shaving, the skin around the stoma should be dried and rinsed thoroughly.
• Activities:
  • Avoid lifting heavyweights.
  • Do not perform activities like jogging or contact sports for up to three months. 
  • You can walk or climb staircases after the surgery. This activity will provide you with strength and make you feel better. 
  • Ask your healthcare practitioner when you can resume your work after the surgery.
• Driving:
  • After assessing your condition, your healthcare provider will guide you regarding the time when you can resume driving. 
  • Usually, you can start driving within six weeks based on your condition.

When to see the doctor?

Inform your healthcare practitioner if you have any of the following symptoms after surgery:

• Injury/cut to the stoma 
• Change in the size, appearance or colour of stoma 
• Bleeding at the connection point of the stoma and skin 
• Fever
• Strong odour of urine 
• A feeling of irritation or deep sores in skin
• Chronic vomiting or nausea 
• Pain in the belly or back
• Cloudiness or pus in the urine 
• A sudden change in the rate of urine discharge
• Breathing issues accompanied by cough or pain in chest.

The following possible complications can arise from this surgery:

• Infection 
• Bleeding 
• Blood clots 
• Restricted urine flow 
• Accumulation of fluid inside the belly 
• Irritation in the skin around the stoma
• Damage to nearby organs 

A follow-up appointment is scheduled six to eight weeks after the surgery. You will need an appointment to change your pouch after the surgery for the prevention of leaks, irritation and infection.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.