Urostomy

What is a urostomy?

A urostomy is the construction of an opening in the abdominal wall (belly) when you need a new passageway for urine. It is done when the bladder has to be removed or bypassed because it is diseased or not working as it should. The urine passes out of the body through an opening called a stoma.

There are 2 types of urostomies.

• Standard or conventional urostomy: The urine is collected in an ostomy bag (collection pouch) attached to the stoma outside of your abdomen. The bag can be emptied when it fills up.
• Continent urostomy: Your healthcare provider makes a pouch inside your body. The pouch is drained through the stoma several times a day with a flexible tube called a catheter.

Your healthcare provider will talk to you about which type of urostomy would be best for you.

Why is this done?

A urostomy is done so that the urine made by the kidneys does not go into the bladder. It may be done when the bladder is not working normally or is diseased. Some common reasons for needing a urostomy are bladder cancer, nerve damage and loss of bladder control, birth defects, and chronic bladder inflammation.

How do I prepare for the procedure?

Your healthcare provider will explain the surgery, including the risks and benefits. Most hospitals have specially trained staff members to teach you what you need to know for self-care. If you are going to have a standard urostomy they can help plan where the urostomy will be on your abdomen by putting a bag on your abdomen several days before surgery to find the best spot. You may want to have family members learn about your care so they can help you at first and give you support and encouragement. This lifesaving, body-changing procedure can affect people in different ways. Understanding how to care for the stoma is the first step toward helping you deal with your concerns.

Plan for your care and recovery after the operation. Find someone to give you a ride home from the hospital. Allow for time to rest. Try to find people to help you with your day-to-day duties for the first couple of days after surgery.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery. You may need to stop some other medicines before surgery.

Your provider will give you instructions on how to prepare for the surgery. You may be told not to eat anything the night before the procedure, and to drink only clear liquids. After midnight and the morning before the procedure, do not eat or drink anything. Do not even drink coffee, tea, or water.

You may be given antibiotics to prevent infection.

What happens during the procedure?

You will be given a general anesthetic before the surgery. The anesthetic will relax your muscles and put you in a deep sleep. It will keep you from feeling pain during the operation.

Your surgeon will make a cut (incision) in your abdomen.

• If you have a standard urostomy, the surgeon will cut the tubes that drain urine from the kidneys into the bladder. A piece of the bowel will be cut out and used as a tube to drain the urine from your kidneys through a hole in your skin. The hole in the skin is called an ostomy. Because the urine will drain all of the time, you will have to have a bag attached to the outside of your abdomen to collect the urine.
• For a continent urostomy, your healthcare provider will make a pouch inside your body with a piece of bowel or bladder. Urine will collect in this internal pouch. It will be drained using a flexible tube called a catheter. You will need to insert the catheter into the pouch several times a day to drain it. You will not have to wear an ostomy bag to collect urine.

What happens after the procedure?

After surgery you will be given intravenous (IV) fluids. You will feel pain from the cut in your abdomen and the drainage tubes. This can be helped with pain medicine and will go away in several days.

At first your diet will be only clear liquids. You will then slowly start eating regular food.

If you have a standard urostomy, at first your bag will be changed by nurses or a specialist called a stoma therapist. They will show you how to do changes yourself. The bag usually needs to be changed every 3 to 5 days.

If you have a continent urostomy, you will be shown how to use the catheter to drain the pouch inside your body.

For either type of urostomy, you will learn how to clean and care for the stoma.

You can go on with your normal lifestyle (including sexual activity) with some adjustments. For example:

• Avoid heavy lifting and contact sports to prevent injury to the stoma.
• If you have a standard urostomy you will need to:
  • Prevent odor by cleaning the bag well and using a bag deodorant.
  • Use a room deodorizer if needed.
  • Empty the bag when it begins to fill to prevent leaking around the seal.
• Do not wear tight clothing over the stoma.

You can learn more about caring for a urostomy from your healthcare provider and:

• The United Ostomy Associations of America
  Phone: (800) 826-0826
  Web site: http://www.uoaa.org.

  This Web site has information and discussion boards, links to suppliers of ostomy equipment and other resources. A detailed Urostomy Guidebook can be downloaded from the site.

• The American Cancer Society
  Web site: http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Urostomy.asp
• The Wound, Ostomy, and Continence Society (WOCN)
  Phone: 1-888-224-9626
  Web site: http://www.wocn.org

  They can help you find a nurse in your area with special training in teaching people about urostomies and how to care for them.

What are the benefits?

This procedure gives you another way to drain urine when your bladder is diseased or has stopped working. It can lessen pain and symptoms. It can also lessen long-term problems.

What are the risks?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• The nerves and blood vessels around the bladder could be cut or damaged.
• Your intestine could leak where the section of it was removed, or it could become narrowed and need surgery.
• Scar tissue called adhesions may form in the abdomen and cause a blockage in the bowel.
• Urine could leak out where the ureters are joined to the section of intestine.
• The ureters could become blocked and keep urine from flowing out of your body.
• The skin around the area where the intestine is sewn to the skin could become infected.
• The cut in your abdomen may not heal well and may get infected.
• You may have bleeding.
• The stoma may get narrowed from scarring and need surgery to correct it.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider if:

• You have a fever over 100°F (37.8°C).
• You have any change or worsening of pain or symptoms.
• You have unusual drainage from the surgery area (including bloody drainage).
• You see blood in your urine.

Call during office hours if:

• You have questions about the procedure or its results.
• You want to make another appointment.