What is a urostomy?
A urostomy is done after your bladder has been surgically removed or if it no longer works. During this procedure, a surgeon creates an opening in your belly, called a stoma. A piece of your intestine is then used to remove urine from your body through that opening.
An alternative to urostomy is called continent urinary diversion. In this procedure, the surgeon uses a piece of your intestine to create a pouch that holds urine inside your body. The pouch either drains to a stoma or replaces your bladder.
Who’s a good candidate?
You may be a good candidate for a urostomy if your bladder has been removed or it no longer works because of:
- bladder cancer
- a birth defect like spina bifida or bladder exstrophy
- damage to nerves that control your bladder
- chronic bladder inflammation
- spinal cord injury
How do you prepare?
Before your surgery, you’ll have tests to make sure you’re healthy enough for the procedure. These may include:
You’ll also meet with your surgeon and wound ostomy continence nurse. They’ll locate a spot on your belly to place the stoma. This area should be flat and easy for you to reach. The nurse will also go over the surgery and explain how to use your ostomy pouch.
Let your doctor know about any prescription and over-the-counter medications you take. You may have to stop taking blood thinners or other medicines a week or so before your surgery. Let your doctor know if you drink alcohol or smoke, too. Quitting smoking before your surgery can reduce your risks and improve your recovery.
The day before your surgery, you may need to go on a liquid diet. Your surgeon will likely tell you not to eat anything after midnight. On the night before your surgery, you’ll take a shower and wash your belly with antibacterial soap.
What happens during the surgery?
Urostomy is an inpatient procedure. You’ll need to stay in the hospital for a few days afterward.
You’ll get general anesthesia. This medication will make you sleep and prevent you from feeling pain during the surgery.
During this procedure, the surgeon will remove a small piece of your intestine, called the ileum. The rest of your intestine will be reconnected so you can have normal bowel movements.
One end of the ileum is attached to your ureters. Ureters are the tubes that urine normally travels through, from your kidneys to your bladder. The other end of the ileum is attached to the stoma. The urine will travel from your ureters through the ileum to a pouch you wear on the outside of your body.
The surgery takes three to five hours. Afterward, you’ll go to a special care unit to wake up and recover from the anesthesia.
What’s the recovery like?
You’ll need to stay in the hospital for four to seven days after your surgery. At first, you’ll have a drain in place to remove fluid from your abdomen.
You may not be able to eat solid foods for a few days. You’ll get nutrients intravenously (IV).
Before you leave the hospital, your ostomy nurse will teach you how to wear the pouch and care for your wound. You’ll also get medication to manage any pain.
You’ll be able to walk when you return home. Avoid strenuous activities and don’t lift anything heavier than 10 pounds for about four weeks.
How do you care for your wound?
Wash your incision with unscented antibacterial soap then pat it dry. Once your surgical dressing has been removed, you can take showers. Don’t take baths until your incision has fully healed.
Before you leave the hospital, an ostomy nurse will show you how to care for your stoma. Right after surgery, the stoma will be red or pink and shiny. It’ll get smaller in six to eight weeks. Your doctor might ask you to measure the stoma once a week to see if it’s growing or shrinking.
Use the right-sized pouch and skin barrier opening for your stoma. If the opening is too small, it could squeeze and damage the stoma. If it’s too big, urine can leak underneath and irritate your skin.
Change your pouch regularly to avoid irritation or urine leakage. Try to empty the pouch when it’s 1/3 to 1/2 full so it doesn’t leak. When you change the pouch, clean the skin around your stoma with water and pat it dry.
What does a stoma look like?
What side effects or complications can happen?
You may bleed a little bit around your stoma. This is normal. But call your doctor if the bleeding:
- comes from inside the stoma
- doesn’t stop within 5 to 10 minutes
You may also have swelling in your genitals and legs. Some fluid might drain through your penis or vagina for a few days after your surgery.
The flow of urine through your stoma can irritate your skin. This can cause gray, purple, or white bumps to form. You’ll wear a skin barrier on the pouch to protect your skin from damage.
Other possible risks from urostomy include:
Call your doctor or ostomy care nurse if you notice these symptoms:
- a lot of bleeding from the stoma opening
- skin sores or severe skin irritation
- change in stoma size, especially if it suddenly gets bigger or smaller by a 1/2 inch or more
- purple, black, or white stoma
- strong odor from the stoma
- bulge or pain in your abdomen
- bloody or foul-smelling urine
How effective is this surgery?
A urostomy can be life-changing. If your bladder has been removed or is damaged, this surgery will allow your body to remove urine so you can go back to your normal activities.
With urostomy, you’ll have to wear a pouch on the outside of your body. You won’t be able to urinate normally like you would after continent urinary diversion surgery.
What can you expect after surgery?
It may take some time for you to get used to living with an ostomy pouch. Your ostomy nurse will help you adjust. Eventually, the process of draining the pouch will become routine. Most people can go back to their normal routine after a urostomy. You should even be able to swim with it.
To help you get more comfortable with the process, join an ostomy support group. Talking to people who’ve been through this surgery can help you adapt to the emotional and physical changes involved.