A urostomy is a surgically created opening to divert urine from its normal route. This surgery is necessary when the bladder must be removed or bypassed. Children who have urinary tract birth defects may need a temporary urostomy. Urostomies are usually permanent for adults. Common reasons for performing urostomies in adults include: cancer of the bladder, spinal cord injury resulting in loss of bladder control, and neuromuscular diseases such as multiple sclerosis.
The most common type of urostomy is called an ileal conduit. To create the conduit, the surgeon isolates a short piece (about 10 cm) of small intestine (bowel) (Diagram #2). The small intestine is reconnected and functions normally. The piece of isolated bowel is closed at one end. The other end is brought to the outside of the abdomen, turned back on itself like a cuff of a sleeve creating The ureters from the kidneys are attached into this piece of small bowel, which is now called the conduit (Diagram #3). The part of the small intestine known as the ileum is used to make the conduit; therefore, the urostomy is called an ileal conduit (Diagrams #2 and #3). The urine is excreted from the kidneys and drains through the ureters into the conduit. From the conduit the urine drains through the stoma. The ileal conduit is not a storage cavity and urine drains most of the time. A pouch must be worn at all times to collect the urine.The visible part of the intestine is called a urostomy stoma. The stoma is usually located on the right side of the abdomen slightly below the umbilicus (navel). The stoma is soft, moist and pinkish-red in colour, similar to the tissue inside the mouth. Immediately following surgery, the stoma is usually swollen and larger than it will be after healing takes place. As healing from your operation occurs, the stoma usually gradually shrinks in size. The size of a stoma varies depending on the individual. The stoma may bleed slightly when wiped or cleansed because many tiny blood vessels are very close to the surface. The stoma usually protrudes slightly from the abdomen; this makes the pouching system easier to adhere to the abdominal skin. There is no feeling in the stoma, it does not hurt when touched or when urine is passed. You cannot control the movement of urine through the stoma. Urine is very irritating to the skin. A pouching system must be worn at all times to collect the urine and protect the skin around the stoma.
The small intestine normally secretes mucus; therefore, the urine will probably always contain some mucus shreds. A large amount of mucus in the urine may be noticed after your surgery, but this decreases over time.A pouching system/appliance is made for containing urine and to protect the skin around the stoma. A variety of urostomy pouching systems is available to meet individual needs. A nurse and/or an ET nurse will show you samples of pouches prior to or after your surgery. Your preferences and lifestyle are important considerations in pouch selection. Sometimes more than one pouching system is tried before a person decides which pouch is most comfortable and best meets their needs. A pouching system/appliance consists of a pouch to collect the urine and a skin barrier to form a seal around the stoma (Diagram #4).
Pouching systems are…
- Odour resistant
- Low profile – not noticeable through clothing
They may be…
- One piece or two pieces
- Disposable or re-usable
- Pre-cut or cut-to-fit the stoma opening
Length of wear time varies, depending on individual needs and type of pouching system. The pouching system needs to be kept clean and free of leaks. The stoma usually shrinks for approximately 6 to 8 weeks following surgery. It is important to measure the stoma each time you change your appliance and to use the appropriate size. You need guidance in selecting the pouching system that is best for you. Enterostomal Therapy nursing services are available in most major cities in Canada to provide this guidance. If ET nursing services are not available in your hospital or community, ask your doctor or nurse where you can find further information, or see the Resource List.
Urostomy pouches have an “anti-reflux” valve preventing urine from flowing from the pouch back onto the stoma. Urostomy pouches also have a tap-like device on the bottom allowing for emptying the pouch when necessary. The pouch should be emptied when it is 1/3 to 1/2 full to help prevent leakage. At night, a special drainage tubing and bottle or bag can be connected to the pouch to help avoid having to get up to empty the pouch. Try leaving a small amount of urine in the pouch before attaching it to the tubing to prevent a vacuum in the pouch. Make sure urine is flowing from the pouch into the drainage bag before you go to sleep. Prevent kinking and pulling of the drainage tubing. If you have concerns, consult with an ET nurse.
Canadian provinces may have health care plans to help offset the cost of ostomy appliances/pouching systems. Specific information can be obtained from your surgeon (urologist), ET nurse, medical/surgical supplier, pharmacist or social services.