Overview of Continent Urostomy

When your bladder isn’t functioning correctly or you have a serious disease like bladder cancer, a new pathway must be made for urine to exit your body. This is where a urinary diversion, or urostomy, may be necessary.

A continent urostomy is one such surgery. Also known as a continent urinary diversion, the surgery involves making a stoma, or opening in your abdomen. From here, a tube is inserted into the stoma to drain urine out of your body. This must be done 4–5 times per day.

Another option is called a neobladder. With this type of continent urinary diversion, a surgeon creates an internal pouch connected to your ureters. The neobladder replaces the functions of your bladder, allowing you to urinate the way you normally do.

A continent urostomy is considered effective, with most people being able to return to their normal activities. This type of bladder surgery also doesn’t usually require any special diet, and you don’t need to wear an ostomy bag to collect urine.

But continent urostomy isn’t as common compared with other types of urinary diversion surgeries, such as an ileal conduit.

Part of this has to do with the type of underlying condition that requires urinary diversion in the first place. Conditions like bladder cancer may require a complete bladder removal. This is often paired with an ileal conduit.

Like other types of ostomy surgeries, a continent urostomy may carry the risk of complications, especially within the first several weeks. These may include:

• stoma irritation or discomfort
• bleeding from the stoma
• urine leakage (incontinence)
• urinary tract infection (UTI)
• bladder stones

A doctor will help you determine the best place to make the stoma. To assist in the process, you may be asked to wear a sample pouch in the desired location.

You’ll wear the sample pouch during activities and times of rest to ensure your comfort.

You can generally expect the following steps:

Before the procedure

1. If you’re undergoing general anesthesia, you’ll need to avoid fluids and foods after midnight on the morning of your urostomy.
2. On the day of your surgery, you’ll see a nurse to check your vitals.

During the procedure

1. A surgeon will first create a stoma in your abdomen by making a hole in your skin.
2. Next, they’ll create a diversion for urine. This is done by creating an internal pouch either placed in your pelvis in place of your natural bladder (neobladder) or your abdominal wall (cutaneous reservoir).
3. The surgeon will connect your ureters to either the neobladder or cutaneous reservoir so they can release urine here instead of your bladder.

After the procedure

A nurse will teach you how to take care of your newly formed stoma. This involves keeping the area clean so that it doesn’t become irritated or infected.

It can take up to 6–8 weeks to fully recover from a urostomy.

The stoma created during this surgery may be pink to red in color, depending on your natural skin tone. It’s normal for it to stick out from the rest of your skin. You’ll also notice that the size of your stoma will shrink after surgery. This is due to decreased swelling.

A nurse will teach you how to care for your neobladder or cutaneous reservoir. With a neobladder, you’ll need to urinate every 2–3 hours throughout the day and every 3–4 hours during the night for the first few weeks. You’ll gradually lengthen the time during the day to 4–6 hours and just once at night.

With a cutaneous reservoir, you’ll need to empty it via a catheter every 2 hours. After a few weeks, you can increase this to every 4–6 hours.

A continent urostomy may be covered by private healthcare insurance. Government programs like Medicare may also cover part of the costs.

While the cost may vary, the average can range between $2,000–$3,700. Keep in mind that this is without insurance, and the cost only includes doctor and facility fees. Other costs, such as for the anesthetic, may be charged separately.

It’s also important to consider separate costs, such as ostomy pouch supplies. Without insurance, these may range from $300–$600 per month.

A continent urostomy is considered a major surgery that you’ll likely have questions about. Below are a few of the most common ones.

What is a continent urostomy?

A continent urostomy is a type of urinary diversion surgery used in cases where your bladder no longer works properly. With this type of urostomy, a surgeon creates a stoma as well as an internal pouch to collect urine instead of your bladder.

What is the difference between continent and incontinent urostomy?

Both continent and incontinent urostomies involve the use of ostomies and bagging systems. The key difference is that while a continent urostomy allows for the emptying of urine at the time of your choosing, incontinent urostomies involve continuous urinary drainage into the collection bag.

What is the difference between ileal conduit, cystostomy, and urostomy?

An ileal conduit is the most common type of urinary diversion surgery. It’s used exclusively in cases of complete bladder removal and involves connecting a part of your intestines called the ileum to your ureters. From here, urine flows out through the manufactured conduit into a collection bag.

A urostomy is a surgery that creates an abdominal opening to help redirect urine from your bladder. A cystostomy is another type of urinary diversion that involves connecting a tube between your bladder and abdominal skin to drain urine into an external bag.

What are the possible complications of urostomy?

While a urostomy is a necessary procedure, it can also lead to complications like skin problems with the stoma, as well as urinary problems.

A continent urostomy, or continent urinary diversion, is a procedure that diverts the flow of urine away from your bladder and to a stoma. Unlike other types of urostomies, you don’t need to wear a urine collection bag.