Urostomy
A urostomy is a surgical procedure that creates a stoma, or opening, in the abdominal wall to allow urine to drain from the kidneys into an external pouch. This procedure is typically performed when the bladder is diseased, such as in cases of bladder cancer, preventing normal urinary function. Urostomies can be classified as conventional, involving an ileal conduit, or as a continent urinary reservoir, which offers patients more control over urine output.
Before the surgery, patients discuss options, risks, and benefits with their surgeon, who will also evaluate the optimal stoma location for comfort and daily activities. Post-surgery, patients receive education on caring for the pouch and may experience initial swelling of the stoma, which typically reduces in size over several weeks. Support from healthcare professionals and ostomy visitors can be vital for addressing body image concerns and practical questions. Innovations in urostomy devices, such as custom-fit covers and improved pouch technology, have further enhanced patient independence and comfort. While there are risks associated with urostomies, including infection and skin irritation, proper care and management can lead to a return to regular activities and improved quality of life.
On this Page
Subject Terms
Urostomy
ALSO KNOWN AS: Urinary diversion
DEFINITION: A urostomy is a surgical opening (stoma) through the abdominal wall that allows urine to drain from the diseased bladder into an artificial pouch, to be emptied intermittently when long-term drainage from the bladder is not possible. A urostomy can be conventional or standard, with an ileal conduit, or feature a continent urinary reservoir.
Cancers treated:Bladder cancer
Why performed: When a bladder is diseased, the body must have a way to excrete urine and liquid human waste. A surgeon creates an urostomy to drain urine from the kidney.
Patient preparation: The surgeon discusses the risks and benefits of the urostomy with the patient and examines the patient’s abdomen to locate the best place for the stoma. Some patients try flat pouches at the predetermined place to see if the location allows maximum comfort and minimal interference in activities of daily living. Patients should tell the surgeon if their work or hobbies need special consideration.
Steps of the procedure: The steps of the procedure depend on the type of surgery performed. In a conventional urostomy, a small pouch or urine reservoir is created surgically from a small bowel segment. A passage is created from the kidney and ureters to the ileal segment that bypasses the bladder (which may or may not be removed). The far end of the ileal segment is brought through the abdominal wall to make a stoma.
After the procedure: Education regarding how to care for a pouch after surgery is provided by an ostomy specialist. After surgery, the stoma may swell but will decrease in size over six to eight weeks. Most healthcare facilities have ostomy visitors who have experienced an urostomy and understand concerns about body image. They can answer questions that the patient may have after surgery. Support groups are also useful.
Ostomates, or people who have had an urostomy, can face many difficulties; however, medical research continues to innovate to make the urostomy process and its devices more palatable. In 2023, Charlotte Böhning created the Gutsy port, a custom-fit port covering for stoma which allows patients to better control their urine output for extended periods of time. This innovation provides patients with greater independence and a feeling of more control over their continence. Other changes to urostomy equipment have also aided patients in living functional and complete lives. Softer covers on stoma hardware keep the body dry, odor barriers control odor, special drains aid in emptying pouches, and the TIES System, a titanium transcutaneous implant, allows for easier draining.
Risks: Typical risks include urinary crystals, infection, and skin irritation. A pouch that fits well, along with adequate fluid intake and appropriate skin care with a protectant barrier, can minimize problems. The patient should notify the healthcare provider if bleeding occurs from the stoma, if ulcers form on the skin around the stoma, or if fever or a strong odor in the urine (a sign of a kidney infection) occurs.
Results: The urostomy can improve for the bladder cancer patient, who can return to most normal activities. Managing the urostomy will become routine with practice.
Bibliography
Griffiths, T. R. L. "Current Perspectives in Bladder Cancer Management." International Journal of Clinical Practice, vol. 67.5, 2013, pp. 435–48.
Konety, Badrinath R., and Sam S. Chang, eds. Management of Bladder Cancer: A Comprehensive Text with Clinical Scenarios. New York: Springer, 2015.
Rayson, Elizabeth. Living Well with an Ostomy. 2nd ed. Victoria: Your Health, 2012.
Recalla, Stacy. "Ostomy Care and Management: A Systematic Review." Journal of Wound, Ostomy and Continence Nursing, vol. 40.5, 2013, pp. 489–500.
Rouholiman, Dara, et al. "Improving Health-Related Quality of Life of Patients With an Ostomy Using a Novel Digital Wearable Device: Protocol for a Pilot Study." JMIR Research Protocols, vol. 7, no. 3, 2018, doi.org/10.2196/resprot.7470. Accessed 16 June 2024.
Schultz, Alexander, et al. "Urostomy and Health-Related Quality of Life in Patients with Lower Urinary Tract Dysfunction." Scandinavian Journal of Urology, vol. 49.1, 2015, pp. 2–7.
“Secure Medical Port For Bag-free Ostomy Care Wins 2023 U.S.A. James Dyson Award.” Dyson, 13 Sept. 2023, www.dyson.com/discover/sustainability/james-dyson-award/Secure-Medical-Port-For-Bag-free-Ostomy-Care-Wins-2023-USA-James-Dyson-Award. Accessed 16 June 2024.