Urostomy is a surgical procedure that creates an opening (stoma) in the abdominal wall through which urine leaves the body.
Purpose
Doctors perform urostomy when a patient has bladder cancer, spinal cord injury, specific types of birth defects, or when the bladder is not functioning properly and must be removed.
Precautions
In an individual who is obese or who has folds in the skin or scars in the abdominal wall, an internal collection sac (reservoir) the patient can empty (catheterize) works better than a passage that lets urine flow out of the body into a collection bag (pouch) worn next to the skin under the clothes.
Description
Urostomy is a form of urinary diversion. Surgeons perform this reconstructive procedure when disease, infection, injury, or congenital abnormality makes it necessary to remove a patient's bladder and create a new channel (conduit) for urine to leave the body.
Surgeons perform urostomy by separating a short piece of the large or small intestine from the rest of the intestine. They attach the separated intestine to the two thick tubes (ureters) that carry urine from the kidneys to the bladder and connect the ureters to the stoma.
Continent and incontinent diversions
An incontinentostomy drains continuously into a small pouch fitted over the stoma and worn under the patient's clothes. The patient wears a collection pouch at all times and empties it several times a day.
To perform a continent urinary diversion, the surgeon uses a piece of the patient's intestine to create an internal reservoir to store urine. The patient does not wear an ostomy pouch but empties the reservoir four to six times a day by inserting a drainage tube (catheter) into the stoma.
Types of urostomy
The most common types of urostomy are the ileal conduit, which uses a piece of the small intestine (ileum) and the colonic conduit, which uses a piece of the large intestine (colon). Orthotopic neobladder is a new type of continent diversion that channels urine into the tube that drains urine from the bladder (urethra) and enables the patient to urinate almost normally.
Temporary urostomy does not involve severing the ureters and is most often performed in children.
Doctors consider the likelihood of disease recurring in the pelvis or urethra as well as the patient's gender to determine which type of urostomy is most appropriate. Neobladders are not appropriate for female patients whose cancer involves the bladder neck or male patients with problems affecting the right colon or small bowel.
If bladder cancer has metastasized or cannot be surgically removed, the surgeon may perform a urostomy without removing the patient's bladder.
Preparation
Before undergoing a urostomy, the patient learns where on the abdomen the stoma will be created, what type of collection device (if any) will be worn, and what changes in appearance the operation may cause.
Nurses encourage the patient preparing to undergo an incontinent urostomy to become familiar with the collection device that will be worn after the operation. They may arrange to have someone who has already had the operation (ostomate) reassure the patient preparing for either an incontinent or continent procedure and answer questions about life after the surgery.
Preoperative restrictions
The patient may be told not to eat certain foods before surgery and must fast for eight hours and have a cleansing enema before the operation.
Fluid and antibiotics may be given to a patient who is frail.
Aftercare
A patient who has undergone an incontinent diversion wears a collection device that is odor-free, not visible under clothing, disposable or reusable, and available at drug stores or medical supply houses or through the mail.
To prevent urine leakage, infection, skin irritation, and odor, the patient should re-measure the stoma and make any necessary adjustments in the size of the flat sponge-like patch that covers and protects it. This should be done during the first few months after the operation (when shrinkage occurs) or whenever gaining or losing weight. Measuring devices and instructions are included in every box of collection pouches.
Some doctors recommend taking Vitamin C to prevent infection-and odor-causing bacteria from accumulating in the urine. Other recommendations include drinking eight to 10 glasses of water a day to reduce the likelihood of kidney infection.
Risks
Because tumors sometimes develop in neobladders, a patient who undergoes this procedure must have a cystoscopy within five years.
Normal results
A patient who has had a urostomy can:
Shower or bathe with or without the collection pouch.
Usually wear the clothes worn before the operation.
Return to work shortly after leaving the hospital, although a doctor's permission is required before doing heavy lifting.
Enjoy intimate relationships.
Participate in athletic activities, but should avoid strenuous contact sports like football or wrestling.
Dietary restrictions are rare.
A woman who has undergone a urostomy should talk with her doctor before becoming pregnant.
Abnormal results
Almost half (40%) of patients who undergo continent diversions and 24.1% of those who undergo ileal or colonic conduits require subsequent surgery to repair leaks or obstructions and correct other surgery-related problems.
A patient who has had a urostomy may also experience:
Cherath, Lata. "Bladder Cancer." 1999. <http://www.findarticles.com/cf_1/g2601/0002/2601000204/print.html>.20 May 2001. 6 July 2001.
Guttman, Cheryl. "Diversion Procedures Require Similar Rein-tervention." June 1999. 18 July 2001 <http://www.findarticles.com/cf_1/m0VPB/6_27/54852652/print.jhtml>.
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