What is a Urostomy?
The normal urinary tract consists of two kidneys, two ureters, one bladder and one urethra. Urine is made in the kidneys and moved through the ureters by squeezing movements (peristalsis) to the bladder. The urine is then stored until the bladder is full and is then passed from the body through the urethra.
A urostomy/ileal conduit is the creation of a new exit route for the passage of urine from the body via a stoma and pouch. The surgical construction of such a pathway through which the urine may travel without interference will allow the kidneys to function at their optimum efficiency.
Forming the stoma
A small section of bowel, usually 12-14cm, is used to form the conduit. The remaining bowel is reconnected for normal function to continue. The kidneys produce urine, which passes down the ureters. The ureters are stitched into the conduit. One end of the conduit is closed and the open end is brought out onto the abdominal wall to form the stoma. During the operation fine tubes called “stents” are inserted into the kidneys via the ureters to assist free drainage of the urine until healing has taken place. These stents either fall out or are removed approximately 10 days after surgery.
The word ‘stoma’ comes from the Greek language and means ‘mouth’.
Why is a urostomy necessary?
There are a variety of reasons why the formation of a urostomy may be necessary, all of which are due to a defect or problem with the urinary system, which needs to be removed or bypassed.
In some types of cancer the bladder will have to be removed.
Babies are sometimes born with a defect in the urinary tract. For example, in Spina Bifida the function of the bladder and urethra are affected.
In conditions such as Multiple Sclerosis, Cerebral Palsy and spinal injury, nerve damage will occur resulting in bladder dysfunction.
Continence problems may also arise due to gynaecological problems, a urinary fistula (a tract from the ureter or bladder) or from other problems with the bladder which prevents the bladder muscles and sphincter from working properly. A condition such as painful bladder syndrome or interstitial cystitis may also warrant a urostomy.
Some people choose a urostomy for social reasons, because it is easier to manage than a defective bladder. With this condition, patients cannot control the flow of urine, causing them embarrassment and problems with the skin, due to it being constantly wet.
There are approximately 11,000 people with a urostomy in the UK and around 800 new ones are created each year.
Thousands of people have discovered how good life is after the operation and are now pursuing an active and rewarding life. Many people consider that this operation has given them a ‘new life’.
A healthy stoma is moist and red, just like the inside of your mouth. The piece of bowel that has been used in the surgery produces mucus to lubricate the lining, to assist the passage of faeces through the bowel. Thus, the conduit too will produce mucus, which is visible in the urine as a whitish, jelly-like substance. This is quite normal and it may decrease in time.
As the stoma does not have nerve endings, it has little sensation and is not painful when touched. However there is a rich blood supply close to the surface, which explains why the stoma may sometimes bleed when it is cleaned. This is of no concern, but reminds you to handle your stoma with care.
Sometimes the stoma can be seen to move – this is the normal contractile movement of the bowel, which now helps to direct the urine outwards into the urostomy pouch.
There are a wide variety of urostomy pouches available, made by many manufacturers. All pouches are waterproof and odour-proof and have skin-friendly adhesives, which act as a protective barrier for the skin around the stoma. The pouches are fitted with a non-return valve, which prevents the urine in the pouch from flowing back over the stoma. The pouches all have taps or bungs at the bottom which allows the urine to be emptied into the toilet when the pouch is becoming full, thus leaving the pouch in place to continue collecting urine.
Pouches are available in two main types – one-piece and two-piece.
Two-piece pouches consist of an adhesive flange, which is fitted to the abdomen around the stoma, and a pouch, which then fits onto the flange. With this system the flange can stay on the abdomen for 3-5 days, with only a need to change the pouch.
One-piece systems comprise of a pouch with the adhesive sealed directly onto it. They can be left on the skin for 1-3 days before the whole system needs to be changed.
Both types are available in a range of pre-cut sizes or with a starter hole that can be cut to fit individual stomas. The pre-cutting option is very useful once the stoma has retained a regular shape.
Urostomy pouches and other items essential for the care of the stoma are available on prescription without charge. Persons under the age of 60 will need to complete an exemption form.