A urostomy, or urinary diversion, is a surgical opening that is created to drain urine from the body after the bladder has been removed or bypassed. The urostomy allows urine to flow out of the body and into a plastic pouch that is worn to collect the urine. This allows for the preservation of normal kidney function.
A urostomy may be performed when a person has had bladder cancer, trauma to the bladder, severe incontinence that does not respond to other therapies or treatments, painful bladder, congenital abnormalities, neurological conditions and diseases, spinal cord injury, chronic inflammation of the bladder, interstitial cystitis, surgery, or radiation damage.
There are different methods to create the urostomy, or urinary diversion, with the most common surgical method being the ileal conduit. To create an ileal conduit, the surgeon removes a short piece of the small intestine. This piece is used as a pipeline for urine to flow out of the body. The ileal conduit is closed at one end, the ureters are inserted into it, and the open end is brought to the surface of the abdominal wall. A new opening is made in the abdomen and the piece of small intestine is sewn to it, and it is called a stoma.
A similar surgical method is the colon conduit, which uses a short piece of the large intestine to bring the conduit through the abdominal wall. These are only done in specific circumstances and are not as common as the ileal conduit.
Below is a drawing of a stoma. A stoma is created by the surgeon on the surface of the abdomen. Each stoma is unique and it will look different from anyone else’s. They may vary in shape and size. A stoma may be swollen right after surgery, and it can take several weeks for it to shrink to its permanent size. Urine begins flowing immediately after surgery. The urine comes through tubes (stents) that are placed in the ureter by the surgeon and they are usually removed before a person leaves the hospital and the urine will then flow directly from the stoma.
A pouch to be worn over the stoma will be selected at the hospital by the staff (in many hospitals it will be the Certified Wound Ostomy Continence Nurse (CWOCN)). After people have returned home, they may need to change the type of system they are using after the swelling goes down or if there are problems with the system. People may want to try different pouching systems to find the one that works the best for them but that is not recommended for at least a few months after surgery unless recommended by their healthcare provider. Urostomy pouches have a drain valve at the bottom of the pouch so that the pouch can be emptied as needed. At night, a bedside collector can be attached to the drain valve with flexible tubing, which allows people to sleep through the night without having to get up to empty the pouch.
If you are considering urostomy surgery, or it has been recommended to you by your doctor, most countries have national ostomy patient support organizations to help you with your decision and to help answer many questions you may have about the surgery and life afterwards. In the USA, people may wish to contact the United Ostomy Associations of America (UOAA) or the WOCN ® Society (WOCN) for support and resources. Also, most manufacturers of ostomy pouches have nurses, patient-focused websites and patient support staff who can help answer questions about skin care, product choices, etc. Many communities have local support groups that are part of the UOAA. Do not hesitate to use these resources.
Medical Reviewer: Carolyn Watts MSN, RN, CWON
Ms. Watts has been a board certified wound/ostomy nurse for over 25 years. She has an active clinical practice as well as teaching both physicians and nurses at Vanderbilt University, Nashville, TN, where she is a Senior Associate in Surgery, Department of Surgery, Section of Surgical Sciences. Ms. Watts has lectured nationally and internationally and authored articles in peer-reviewed journals. She has been very active in the national WOCN Society and is currently serving as President (2015-16).