A urostomy is a surgical procedure that creates a new pathway for urine to exit the body. This involves forming an opening, called a stoma, on the abdomen, through which urine is collected in an external pouch. The procedure is performed when the natural urinary system is compromised due to various medical conditions, such as bladder cancer, trauma, or certain congenital defects.
The Possibility of Urostomy Reversal
While many urostomies are permanent, reversal is a possible, though complex, procedure in specific circumstances. The feasibility of reversal largely depends on the original reason for the urostomy. For instance, temporary diversions, often created to allow healing of the urinary tract, have a higher potential for reversal compared to cases where the bladder was permanently removed. The type of urostomy performed also influences the possibility of reversal, with certain configurations being more amenable to reconnection than others.
Criteria for Reversal Candidacy
Determining suitability for urostomy reversal involves a medical and surgical evaluation. A patient’s overall health plays a significant role, as the body must be able to withstand another major surgery. Kidney function is also assessed to ensure the kidneys can adequately filter waste once the urinary tract is reconnected.
The condition of the urinary tract and bowel (if used for reconstruction) is carefully examined for healing and absence of active disease. Imaging and endoscopic evaluations may be performed to check for leaks or obstructions. The absence of active disease is a prerequisite for considering reversal. A patient’s psychological readiness and understanding of potential outcomes are also considered, as recovery can be challenging.
The Reversal Surgical Procedure
Urostomy reversal surgery aims to restore the natural flow of urine by detaching the existing stoma from the abdominal wall and reconnecting the urinary tract. This may require rejoining the ureters to the bladder, or, if the bladder was removed, creating a new bladder (neobladder) from a section of the patient’s bowel.
The complexity of the surgery varies depending on the original urostomy type and the extent of reconstruction required. The surgeon will then close the stoma site on the abdomen. The operation can be performed either through a large incision or using minimally invasive (keyhole) techniques.
Recovery and Outcomes After Reversal
Following urostomy reversal, patients have a hospital stay until bowel function returns. Pain management is provided, and patients are encouraged to begin light activity to aid recovery and promote bowel function.
Short-term complications can include infection, temporary cessation of bowel function, or leakage at the reconnection site. Long-term outcomes vary, but patients may experience changes in urinary habits, which can often be managed with pelvic floor exercises and dietary modifications. Regular follow-up care with the surgical team is important to monitor healing and address any ongoing concerns.
When Reversal Is Not Possible
In certain situations, urostomy reversal may not be a viable option. This includes cases where there has been extensive bladder removal, recurrent cancer, or significant irreversible damage to the urinary system.
For individuals where reversal is not possible, adapting to life with a permanent urostomy is necessary, which involves learning proper stoma care, including pouch changes and skin protection. Support resources are available to help individuals adjust and maintain a good quality of life. While a permanent urostomy requires ongoing management, many individuals lead full and active lives.