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URETEROSTOMY

URETEROSTOMY

Ureterostomy for temporary supravesical urinary diversion is rarely performed today because expertise in pediatric percutaneous radiologic and endourologic techniques has become available in most tertiary referral centers. Historically, ureterostomy was used to decompress an obstructed or infected upper pole,21 and it is still considered an option in very small neonates.22 Ureterostomy is also very effective for preservation of renal function where maximally effective upper tract drainage is required. Finally, supravesical diversion may be indicated in a patient with posterior urethral valves, whose renal function fails to improve after maximal bladder drainage, and there is suspicion of a ureterovesical junction obstruction.

Temporary diversion is most commonly accomplished with a low loop ureterostomy because this is easily reversed. An end ureterostomy is most useful for an ectopic ureter because it eventually would require transaction and ureteroneocystostomy for reconstruction. The resultant proximal decompression may facilitate subsequent reconstruction because ureteral tapering can be avoided in some cases. High diversion, at the level of the kidney, is performed through a flank incision and can be performed as a loop ureterostomy, Sober ureterostomy, or end ureterostomy. Similar to the cutaneous pyelostomy, these procedures are rarely performed today because subsequent reconstruction of the ureteropelvic junction can be very difficult. Contemporary practice in this scenario usually results in a percutaneous nephrostomy tube because this is less disruptive to the pelvis and its blood supply.

A doctor may recommend a ureterostomy when the body cannot rid itself of urine normally. There are several reasons why your doctor may recommend a ureterostomy, including if you:

  • Have a birth defect, such as spina bifida
  • Have had your bladder removed (possibly because of cancer)
  • Have a bladder that no longer works properly
  • Have a spinal cord injury

A ureterostomy permanently reroutes the flow of urine through an opening in the abdominal area to a collecting pouch outside of the body.

If urine cannot leave the body, it can cause urinary tract infections, kidney failure and even death if the problem is not resolved.

How is a ureterostomy done?

G10 Ureterostomy | SpringerLink

During a ureterostomy, a surgeon disconnects one or both ureters (the thin tubes attached to the kidneys) from the bladder. The ureters are then attached directly to the abdominal wall to a surgically created opening in the skin called a stoma. A stoma can be up to three inches wide, and allows wastes to pass out of the body. The stoma does not have a sphincter, or a muscle, that allows it to open and close, so it is unable to control the flow of urine.

Because the bladder is no longer part of the process, the urine does not have a place to collect before exiting the body. Instead, it exits the body directly into a plastic pouch that is attached to the outside of the body around the stoma.

After a ureterostomy, how does the new system work?

Your new urinary system will work in the following way:

  • The pouch is placed outside the stoma (the opening in the abdomen) and collects the urine from the body.
  • There are two pieces to the pouching system: a barrier and a collecting pouch. (They sometimes come as one unit.) The square-shaped barrier piece has a hole in the center that fits over the stoma and sticks to the skin. The sticky substance on the barrier is strong enough so that urine does not leak outside of the pouch.
  • The pouch attaches to the barrier and collects the urine as it leaves the body.

Most people empty the pouch about as often as they used the bathroom before the ureterostomy. Typically, you empty the pouch when it is about one-third to one-half full. There is a valve at the bottom to allow the urine to be emptied into a toilet without removing the pouch from the stoma.

At night, you can attach a piece of flexible tubing to the valve on the pouch to allow urine to flow into a larger pouch while you are sleeping.

Pouches lie flat against the body and are attached securely to the skin. Clothing fits over the pouch and covers it, so it is not noticeable to others.

RECOVERY AND OUTLOOK

What happens after a ureterostomy?

After the ureterostomy, a caregiver will show you how to clean and care for the stoma, the skin around the area, and the pouch. You will also learn how and when to change the pouch.

Do I have to restrict activities after a ureterostomy?

You will need to restrict your activities, especially driving and heavy lifting, for the first four to six weeks after the surgery. The wound must heal before you can continue doing strenuous physical activities. When the stoma has healed, you can usually return to your normal lifestyle, including swimming and other water sports. The doctor may recommend that you not participate in full-contact sports, such as football or karate.

How should I take care of the stoma and pouch?

A nurse will teach you how to care for a stoma and how to change the pouch regularly.

It is important that the stoma remains clean and dry. Every day, you should:

  • Wash the stoma and surrounding skin with mild soap and water.
  • Rinse the area thoroughly.
  • Dry the stoma completely.

The pouch must also be changed on a regular basis. The old pouch should be thrown away and a new pouch placed every five to seven days.

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