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by Neff DM
(Urinary Diversion Surgery)

Definition

A urostomy allows urine to pass through an opening made in the belly wall to a bag outside of the body. An internal pouch can also be created using the intestine. This surgery will not limit activities.

Once healed, a urostomy shouldn’t limit your activities.

The Female Urinary System
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Reasons for Procedure

This procedure is done if urine cannot leave the body as it normally would due to problems such as:

  • Bladder cancer
  • Structural defects—some may have existed since birth
  • Swelling that has lasted a long time
  • Nerve or muscle problems

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over possible problems such as:

  • Irritated skin
  • Excess bleeding
  • Problems from anesthesia, such as wheezing or sore throat
  • Fluid buildup in the belly
  • Blocked urine flow
  • Organ damage
  • Infection
  • Blood clots

Before your procedure, talk to your doctor about ways to manage things that may increase your risk of problems such as:

  • Smoking
  • Drinking excess alcohol
  • Chronic disease such as diabetes or obesity

What to Expect

Prior to Procedure

The surgical team may meet with you to talk about:

  • Anesthesia options
  • Any allergies you may have
  • Medicine, herbs, and supplements that you take, and if you need to stop taking them before surgery
  • Fasting before surgery—not eating or drinking after midnight the night before surgery
  • Whether you need a ride to and from surgery
  • Specialists you may need to see
  • The doctor may also look at your belly to decide where to put the stoma, and you may be asked to wear a pouch as a practice

Anesthesia

General anesthesia will block pain and keep you asleep during the surgery.

Description of the Procedure

An incision is made in the belly to access the area. There are several ways to create a new path for the urine to flow. Your doctor will discuss the options with you.

Most methods require a stoma. A stoma is an opening made through the belly wall. A small section of small or large intestine will be used to make a path between the ureters and the stoma. Ureters are tubes that carry urine from the kidneys to the bladder. There are 2 ways this is often done:

  • Conventional—The intestine is shaped like a tube. It allows urine to flow freely from the stoma into a bag worn outside the body.
  • Continent—The intestine is shaped like a pouch. This will let you store the urine in your body until you drain it with a special tube called a catheter.

A third type, called a neobladder, does not need a stoma. A pouch is made from the small intestine. The ureters and urethra (the tube that carries urine out of the body) are connected to it much like the original bladder. Urine can then pass from the body like it did with the bladder.

The incisions are closed with stitches and bandaged.

How Long Will It Take?

About 2 to 5 hours.

Will It Hurt?

Anesthesia will prevent pain during surgery. Medicines will help ease pain after.

Average Hospital Stay

You will be in the hospital for a few days. If there are problems, you may need to stay longer.

Post-procedure Care

At the Hospital

After the procedure, the care team may:

  • Give you pain medicine
  • Give you IV nutrition while your intestines heal
  • Teach you how to change the ostomy bag or drain the catheter, depending on how your surgery was done
  • Teach you how to take care of the stoma

During your stay, the care team will take steps to lower your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to lower your chance of infection such as:

  • Washing your hands often and reminding the care team to do the same
  • Reminding the care team to wear gloves or masks
  • Not allowing others to touch your incision
At Home

It will take about 2 months to recover. Physical activity will be limited during this time. You will need to delay your return to work.

The stoma will be round or oval. It will also be red. It may get bigger or smaller for up to 2 months after the surgery.

Problems to Look Out For

Call your doctor if you are not getting better or you have:

  • Fever or chills
  • Nausea or vomiting that will not go away
  • Pain that is not controlled with the medicines you were given
  • Pus, cloudiness, or strong odor in your urine
  • Redness, swelling, or bleeding from the stoma site
  • Strange changes in stoma size or color
  • Change in amount or frequency of passing urine
  • Back or belly pain
  • Cough, breathing problems, or chest pain

If you think you have an emergency, call for medical help right away.

RESOURCES

American Cancer Society  https//www.cancer.org 

United Ostomy Associations of America  https://www.ostomy.org 

CANADIAN RESOURCES

Canadian Cancer Society  https://www.cancer.ca 

Health Canada  https://www.canada.ca 

References

Bladder cancer. EBSCO DynaMed website. Available at:   . Accessed February 11, 2022.

Hsu MY, Lin JP, et al. Preoperative stoma site marking decreases stoma and peristomal complications: a meta-analysis. Journal of Wound Ostomy Continence Nursing, 2020;47(3):249-256. Available at: https://pubmed.ncbi.nlm.nih.gov/32118803. Accessed February 11, 2022

New ostomy patient guide 2020. United Ostomy Associations of America. Available at: https://www.ostomy.org/wp-content/uploads/2020/10/UOAA-New-Ostomy-Patient-Guide-2020-10.pdf. Accessed February 11, 2022.

Post-op and recovery—Urostomy Association. Available at:  https://urostomyassociation.org.uk/literature%5Fcategory/post-op-and-recovery/ . Accessed February 14, 2022.

Urostomy guide. United Ostomy Associations of America website. Available at: https://www.ostomy.org/wp-content/uploads/2018/03/UrostomyGuide.pdf. Accessed February 11, 2022.

Your urostomy. American College of Surgeons website. Available at: https://www.facs.org/-/media/files/education/patient-ed/ostomy%5Fskills/your%5Furostomy.ashx. Accessed February 11, 2022.

Revision Information

  • Reviewer: EBSCO Medical Review Board Adrienne Carmack, MD
  • Review Date: 05/2018
  • Update Date: 06/15/2018