What is a urostomy?
It is a surgical procedure to create a new exit route for urine to leave the body via a stoma. This way, the bladder gets bypassed completely. The bladder can either remain in the body or, when this isn’t possible, it might be removed in what’s called a cystectomy. However, whether the bladder remains in the body or not, a urostomy is always permanent and can’t be reversed.
For the stoma, a surgeon will take a short piece of your small intestine from which a tube or spout – called an ileal conduit – is created. This will then be connected to your ureters, so the urine of both kidneys is pumped into it, leaving the body through the stoma. The best location for the stoma will be decided by a specialist ostomy nurse and the surgeon performing the procedure. This is usually on a flat, easy to reach surface of your abdomen. The urine leaving the body will then be collected in a urostomy pouch or a larger urine drainage bag.
What can lead to a urostomy?
A urostomy might become necessary due to many different reasons – all of them related to your bladder.
Bladder Cancer: When you are suffering from bladder cancer, there is a chance that all or part of your bladder needs to be removed. If this is the case, you are likely to need a urostomy in order to pass urine.
Trauma: If you experience any type of damage to your bladder – whether this is due to blunt force trauma, penetrating injuries, or spinal cord injuries – it is possible that you require a urostomy.
Congenital Reasons: Certain birth defects like spina bifida or cerebral palsy can cause defects to the urinary tract. These conditions can lead to chronic or repeat bladder issues and a urostomy can be live saving.
Interstitial Cystitis or Painful Bladder Syndrome: If you’re suffering from frequent, urgent, and painful bathroom trips you might be suffering from interstitial cystitis. When initial treatments like dietary changes and medication are unsuccessful and there is no improvement, your doctor might recommend a urostomy.
Drug Use: Prolonged drug use, especially ketamine, can cause severe bladder issues as it takes away the lining of the bladder. Once this has happened, it can’t be repaired, and your bladder might have to be removed. If this is the case, a urostomy will become necessary.
Social Reasons: If you have been suffering from constant bladder problems, you might find living with a urostomy easier as it will spare you the embarrassment, stress, and inconvenience of not being able to control your urine flow.
What are the potential risks of a urostomy?
As with any other surgical procedure, a urostomy comes with the risk of possible complications. For example, you might experience some bleeding around the stoma. A little bit of blood is completely normal right after your procedure. However, if it looks like the blood is coming from inside your stoma and doesn’t stop within 5 to 10 minutes, please call your nurse or doctor. After surgery, you might experience some swelling in your legs and genitals and it is possible that you’re still passing some fluid “the normal way”. This is nothing to be worried about and should usually stop within a few days. Do consult your doctor if it doesn’t, however! Other possible surgery risks include infection, blood clots, or the development of pneumonia. Latter is especially likely to happen if fluid enters the lungs during the procedure. If you experience any of the following symptoms after your surgery, please get in touch with your doctor or nurse:
- Fever
- Strong odour coming from your stoma
- Change of size in your stoma – especially if it gets bigger or smaller by half an inch or more
- A lot of bleeding coming from the stoma opening
- Skin sores and severe skin irritation
- Your stoma turning purple, black, or white
- Sudden bulges or pain in the abdomen
- Bloody or foul-smelling urine
If you have any doubts, or just need a little bit of reassurance, we’re always happy to listen here at Vyne. Our customer care team will happily talk to you about your worries and concerns – but remember to also ring your GP if you think something isn’t quite right.
The procedure
Before the surgery
Prior to the surgery, your doctor will perform various tests to make sure you are healthy enough for the procedure. These tests usually include an EKG, blood tests, and a chest X-ray. You will also meet with the surgeon performing your procedure as well as a specialist ostomy nurse to locate the exact spot where your stoma will be placed. This is usually on a flat part of your abdomen that’s easy for you to reach. The nurse will also go over the surgery with you and show you how to use a urostomy pouch.
If you are taking any medication, whether it is prescription or over-the-counter stuff, you should tell your surgeon and nurse about it. You will have to stop certain medicines, like blood thinners, a week or more before surgery. If you are a smoker, it would be amazing if you could quit smoking prior to your procedure as this improves your chances of recovery drastically. A day before your surgery, you will likely be put on a liquid diet and, as of the evening before, your doctor or nurse will probably ask you to not eat or drink anything until after the surgery.
During the surgery
A urostomy is always an inpatient procedure. This means you will need to stay in the hospital for a few days before and after the surgery. So have a bag packed with everything you need – from your toothbrush to a good book! The procedure itself will be performed under general anaesthesia and, if everything goes to plan, it should be over within 3 to 5 hours.
During the procedure, the surgeon will remove a piece of your small intestine – from the ileum, to be precise – and then reconnect the rest of it to make sure your bowel movements aren’t affected. The part that has been removed from your ileum is then attached to your ureters and creates the stoma. After the surgery is completed, urine will drain from the kidneys into the ureters, through the ileum into an external pouch that is attached to the stoma.
Recovery
Generally, you can expect to stay in hospital for about 4 to 7 days after the surgery. You might not be able to eat solid foods for a few days and there will likely be a drain in place to remove any excess fluid form your abdomen. Before you can leave the hospital, a specialist ostomy nurse will make sure you know how to use your urostomy pouch and how to care for your wound. After the surgery, you will likely require some pain medication for a short period of time as it can be a little bit sore. If you are mobile, you will be allowed to walk when returning home, but you should avoid strenuous activities and don’t lift anything heavier than 10 pounds or 4.5 kilograms for about 4 weeks.
The urostomy pouch
As the urine leaves your body through the stoma, it’s collected in a special, waterproof bag that is attached to your abdomen. This is called a urostomy pouch. These bags generally come with a non-return valve to stop urine flowing back into the kidneys. This is important in order to prevent urinary infections. Your urostomy pouch will also likely have a tap at the bottom to make it easier for you to empty the bag. Something, that you will have to do multiple times a day.
Urostomy pouches come in many different shapes, forms, and sizes and your urostomy nurse will be able to help you find the right one for your individual needs. You can also speak to our customer care team, who can help you find the right pouch for you if you’re not having the best time with your current one. All urostomy pouches have a bag to collect and store urine and an adhesive barrier that sticks to the skin. The latter is to ensure that urine doesn’t come into direct contact with your skin. There are one-piece systems, which means that the pouch and the adhesive baseplate are attached together in one single unit. This means, that every time the ouch is removed you will also have to change the skin barrier. With two-piece systems, the pouch and the skin barrier are two separate units that are clipped together. This means that, even when the pouch is changed, the baseplate doesn’t have to be changed every time. It’s important that you always have enough bags to keep you going, which we can help with. Either online or over the phone, we’ll help you figure out what you need and deliver it straight to your door.