Urostomy & Mine....


What is a Urostomy?

The normal urinary tract  (Left) 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 (Right) 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.
Why Might a Urostomy be 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.
  • Bladder Cancer
  • Birth Defects in the urinary tract (i.e. Spina Bifida)
  • Multiple Sclerosis
  • Cerebral Palsy
  • Spinal Injury or nerve damage resulting in bladder dysfunction

Continence problems may also arise due to gynecological 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 skin problems, due to constant wetness.




How is the Urostomy Stoma Formed?


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.




Conventional Urostomy








To create an ileal conduit, a segment of the small bowel (ileum) 6-8 inches long is excised near the entrance into the large bowel. The ileum is reconnected. The ureters are detached from the bladder and implanted into the ileal segment. The bladder may or may not be removed. The distal end of the ileal segment is brought through the abdominal wall and a stoma is formed on the abdomen, usually the right side. The proximal end of the ileal segment is sutured closed. This surgery is permanent. The
urine is not controlled and will require wearing a collection pouch attached to the abdomen at all times.      

The small intestine produces mucous naturally. The segment of intestine that was used to form the ileal conduit will continue to produce mucous and will collect in the pouch.


   
For more Urostomy information, please visit www.ostomy.org     


Indications
  • cancer of bladder
  • neurologic dysfunction
  • birth defects
  • chronic inflammation of bladder

Discharge
  • urine
  • some mucus
   

Management
  • skin protection
  • drainable, valve-end pouch
  • adaptable to night drainage