A urostomy is a surgical procedure that creates a new pathway for urine to exit the body when the bladder or the natural urinary tract is no longer functional. This operation is a form of urinary diversion, bypassing the original system that collects and stores urine. The goal is to provide a reliable and manageable method for urine drainage when the native bladder is diseased, damaged, or has been surgically removed.
Defining the Urostomy and Its Purpose
A urostomy involves surgically creating an opening, known as a stoma, on the surface of the abdomen to allow urine to drain out. This procedure is performed when the bladder is unable to function correctly, has been severely damaged, or must be removed entirely. The stoma reroutes the flow of urine from the ureters, which carry urine from the kidneys, directly to the outside of the body.
The primary medical indications for this surgery center on conditions that compromise the lower urinary tract’s integrity or function. The most frequent reason for a urostomy is after a cystectomy, the surgical removal of the bladder, often performed to treat invasive bladder cancer. Other indications include severe bladder dysfunction due to trauma, neurological damage (such as from a spinal cord injury), or congenital abnormalities.
The diversion provides an exit route for urine, preventing it from backing up and damaging the kidneys. The procedure ensures the continuous flow of urine, which is essential for maintaining kidney health and preventing serious infections. The urostomy allows individuals with compromised bladders to manage urinary elimination in a controlled manner.
The Mechanism of Urinary Diversion
The most common form of urostomy is the ileal conduit, which utilizes a small segment of the small intestine (the ileum) as a drainage channel. A surgeon isolates a piece of the ileum, typically 6 to 8 inches long, ensuring its blood supply remains intact. The remaining ends of the small intestine are reconnected so that the digestive process is not interrupted.
The ureters are detached from the bladder and connected to one end of the isolated ileal segment. This section acts as a passive conduit for urine flow. The other end of this segment is brought through the abdominal wall and stitched to the skin, creating the stoma.
The stoma is a small, moist, reddish-pink bud of tissue connecting the internal conduit to the outside. Since it is made from intestinal tissue, it has no muscle or nerve endings, meaning the passage of urine drains continuously and uncontrollably. A specialized, adhesive pouching system is worn over the stoma at all times to collect the urine.
Types of Urostomies
Urinary diversions are categorized into two main types: incontinent and continent diversions. This distinction determines whether an external collection pouch is always necessary for urine collection and storage.
The ileal conduit is an incontinent diversion because urine drains continuously into an external bag. This method is favored for its simplicity and lower complication rate, making it a widely used technique following bladder removal. The pouching system adheres to the skin around the stoma, collecting the urine immediately.
Continent urinary diversions use an internal reservoir surgically created to store urine. Procedures like the Indiana Pouch use a portion of the large intestine to form a pocket with a valve mechanism to prevent leakage. The person does not wear an external bag but must periodically insert a catheter through a small stoma to empty the internal pouch. This allows control over the timing of urine release, mimicking natural bladder function.
Managing Daily Life with a Urostomy
Living with a urostomy requires establishing a routine for managing the external collection device, known as the appliance or pouching system. The pouch must be emptied several times daily when it is about one-third full to prevent the weight of the urine from compromising the adhesive seal. The entire appliance, including the skin barrier that adheres to the abdomen, is typically changed every few days.
Proper skin care around the stoma, known as the peristomal skin, is necessary to prevent irritation from continuous exposure to urine. The skin must be kept clean and dry, and the pouching system must be sized precisely to fit snugly around the stoma. Using specialized adhesive barriers and powders helps maintain the skin’s integrity and ensures a secure seal.
Another important aspect of daily management is ensuring adequate hydration, which helps keep the urine diluted and prevents the formation of urinary crystals. Because the ileal conduit is made from intestinal tissue, it naturally produces mucus, which appears as strands in the urine. Maintaining good fluid intake can help manage the thickness of this mucus. Many people find support through specialized ostomy nurses who provide guidance on appliance selection and troubleshooting, easing the emotional adjustment to this life change.