A urinary ostomy is a surgically created opening, called a stoma, that allows urine to exit the body after the natural pathway has been altered or removed. This procedure, also referred to as a urinary diversion, reroutes the flow of urine from the kidneys to an opening on the abdominal wall. The stoma is typically formed from a segment of the small or large intestine and serves as the new exit point for urine, which is collected in an external pouching system. The procedure is necessary when the bladder or lower urinary tract can no longer function properly or safely.
Medical Reasons for Urinary Diversion
The need for a urinary ostomy arises when the bladder must be removed or is too damaged to store or pass urine without causing harm to the kidneys. The most common indication is bladder cancer, which often requires a radical cystectomy (complete removal of the bladder). Without the bladder, a new route for urine must be established.
Other medical conditions that necessitate a urinary diversion include severe trauma to the urinary tract, chronic bladder infections, or damage caused by radiation therapy for pelvic cancers. Neurological disorders, such as multiple sclerosis or spina bifida, can also impair bladder function. Congenital abnormalities or birth defects that obstruct urine flow are also reasons for this procedure.
Types of Urinary Ostomies
Urinary ostomies are categorized into two main types based on how they manage urine flow: incontinent and continent diversions. Both methods use a segment of the patient’s own intestine to create the new urinary pathway. The choice of diversion depends on the patient’s overall health, anatomy, and lifestyle preferences.
The most common type is the incontinent diversion, often called an ileal conduit or urostomy. A short section of the small intestine, typically the ileum, is isolated and used as a conduit. The ureters, which carry urine from the kidneys, are connected to one end of this segment, and the other end forms the stoma on the abdominal wall. Urine drains continuously through this stoma, requiring the constant wear of an external collection pouch.
Continent urinary diversions are less common and store urine internally, offering the patient control over when they empty the reservoir. Surgeons create an internal pouch from a segment of the small or large intestine (e.g., a Kock pouch or Indiana pouch). This pouch has a valve mechanism that prevents urine from leaking out through the stoma.
The patient empties a continent diversion several times a day by inserting a catheter through the stoma and into the reservoir. This method eliminates the need for a continuously worn external pouch, providing greater discretion. A variation is the neobladder, which connects the pouch directly to the urethra, allowing the patient to urinate closer to the natural way, though this option is not suitable for all patients.
Basic Stoma and Appliance Management
Living with a urinary ostomy requires diligent management of the stoma and the collection system for health and comfort. The stoma is a reddish-pink, moist opening on the abdomen, similar in appearance to the inside of the mouth. Since the stoma has no nerve endings, the process of urine draining or touching the stoma is not painful.
The external collection device, or pouching system, is secured to the skin around the stoma by an adhesive skin barrier. These systems are waterproof and odor-proof, utilizing a non-return valve to prevent urine from flowing back onto the stoma. The skin barrier protects the surrounding skin from constant exposure to urine, which can cause irritation if not properly managed.
The pouch must be emptied regularly throughout the day, typically when it is about one-third to one-half full, to prevent the weight of the urine from pulling on the skin barrier seal. Most people empty their pouch every two to four hours, similar to pre-surgery bathroom habits. The entire pouching system is changed on a routine schedule, often every three to seven days, depending on the product used.
Skin care around the stoma, known as peristomal skin, involves cleaning the area gently with warm water and ensuring the skin is completely dry before applying a new skin barrier. Avoiding soaps or lotions is recommended, as they can interfere with the adhesive’s ability to stick securely. Proper fitting of the skin barrier is important; the opening should be only slightly larger than the stoma to prevent urine from contacting and irritating the skin.