Urine is a normal part of your body, something we don't think about much, right? Urine, which is produced by the kidneys, travels through two tubes and collects in the bladder, where it is released when needed. But imagine what happens if your bladder stops working for some reason, or if it has to be removed? There is no way for urine to leave the body. Today we are going to talk about a special surgery that comes to the rescue in such a situation.
What is a ureterostomy in simple terms?
Simply put,
a ureterostomy is a surgical procedure in which the two tubes that carry urine from your kidneys to your bladder (called `ureters`) are removed from your bladder and are instead connected to a small opening in your skin or abdomen. This new opening is called
a stoma . It's like this. Imagine two water pipes connected to a water tank. Now the tank is broken. What do we do? We remove the tank and bring the two water pipes straight out. The same thing happens here. We bypass the bladder (water tank) and make the urine pipes (`ureters`) go directly out of the body through that `stoma`. Then, the urine comes directly from the kidney and out of the body through this `stoma`. To collect this urine, a special plastic bag, called a pouch, is placed around the stoma. You will need to empty the pouch as many times as you normally urinate. For a small child, this urine can also be collected in the diaper.
This surgery creates a way for urine to pass safely from the body, even if the bladder is not functioning properly. This is often a permanent procedure.
Who needs this surgery?
Your doctor may recommend this surgery if your bladder is unable to empty urine normally. There can be several reasons for this.
| Reason | A simple explanation |
|---|
| Bladder removal | Having to completely remove the bladder due to cancer or another medical condition. |
| Bladder damage | Damage to the bladder due to an accident or other cause, resulting in loss of function. |
| Conditions that come from birth | Some conditions that are present at birth, such as Spina Bifida, can cause the bladder to not function properly. |
| Spinal cord injury | Inability to control bladder function due to damage to the spinal cord. |
What do you do before surgery?
Before undergoing this surgery, the doctor will perform several tests to determine the exact condition of your body.
- Kidney function tests: Check how well your kidneys are working.
- Blood tests : Find out about the general health of the body.
- Imaging tests: A test such as an X-ray or ultrasound scan takes pictures of the kidneys and urinary system.
- Retrograde Pyelogram: In this, a special liquid (dye) is inserted into the urethra and an X-ray is taken.
- CT scan: This can take cross-sectional images of the body and provide a clearer picture.
- MRI : This can also produce very clear images of the kidneys and urinary tract.
Additionally, a doctor or nurse will talk to you before surgery to determine the best place to place the stoma. It is usually placed
in a place that is easily visible to you, will not get caught in your clothes (e.g., a belt), and is free of skin folds .
How does the surgery happen and how does this system work?
During the operation, the surgeon will separate one or both of your urethras from your bladder and connect them to the newly created `stoma`. Now, urine will not pass into the bladder. Now let's see how this new system works. The `stoma`, that is, the opening, does not have a muscle (`sphincter`) that stops urine from flowing out, like the one in our urethra. Therefore
Urine cannot be controlled. It continues to flow out of the kidney drop by drop. This is how urine is collected: 1. A pouch is attached over the stoma: This `pouching` system has two parts. One is the `barrier`. The other is the `collecting pouch`. Sometimes there are cases where both of these are combined. 2. `Barrier`: This is a square-shaped device with a hole in the middle that fits the `stoma`. It is glued to the skin with a special adhesive. Therefore, urine does not leak out. 3. `Pouch`: This bag is connected to the `barrier`. Now the urine coming from the kidney is collected directly into this bag. Usually, the bag needs to be emptied when it is one-third or one-half full. You can empty your urine into the toilet without having to remove the pouch by opening a small valve at the bottom of the pouch. At night, you can connect a tube to this valve and have the urine collect in a larger pouch. This pouch is hidden under your clothes so it is not visible. How to care for the stoma and pouch?
After surgery, your doctor or nurse will teach you how to keep your stoma, the skin around it, and the pouch clean. They will also teach you how to change the pouch. It is very important to keep your stoma clean and dry at all times. You should do the following every day:- Wash the stoma and the skin around it using a mild soap and water.
- Rinse with water until the soap is gone.
- Then let it dry thoroughly.
The pouch also needs to be changed at the right time. Usually, the old pouch needs to be completely removed and a new one put in after 5 to 7 days . What are the risks and complications of the surgery?
As with any surgery, there are some risks involved. Discuss these with your doctor before having the surgery.- Infection.
- Bleeding .
- Hernia.
- Redness , swelling, or other allergic reactions around the stoma.
- Failure to achieve the expected results from surgery.
- Formation of scar tissue.
When do you need to talk to the doctor?
You should always pay attention to your stoma and the skin around it. If you notice any changes, tell your doctor immediately. Skin changes around the stoma: Signs of infection
| Features to look out for | Description |
|---|
| Skin redness or rash | If the skin around the stoma is red and looks like eczema. |
| Skin rash or crusting | If the skin looks dry, cracked, or injured. |
| Skin lesions | Skin lesions can occur due to urine leakage between the pouch and the stoma. |
| Change in urine | Dark urine, blood in the urine, excessive mucus, or a strong odor. |
| Other symptoms | Back pain, fever, nausea and/or vomiting, loss of appetite. |
Are Urostomy, Nephrostomy, and Ureterostomy the same?
No. Although all three of these are surgeries that change the way urine is excreted, they are different from each other.- Urostomy: This is a common name. Ureterostomy is also a type of urostomy. However, there are other methods of urostomy. For example, taking a piece of the small intestine and creating a new urethra.
- Nephrostomy: This involves inserting a tube (catheter) directly into the kidney, which collects urine outside the body into a bag. This is usually done for people with blocked ureters. This is often temporary.
A ureterostomy is a different procedure, where the urethra is connected directly to the skin. It can be a little difficult to adjust to life after the surgery. You may feel uncomfortable about not being able to urinate normally like other people. But talk to your doctor about it openly. He or she can give you the emotional support you need or put you in touch with people who can help you. Remember, you are not alone. There are many other people who have had this surgery. Also, think of this surgery as a way to help you live a better, longer life. Take-Home Message
- A ureterostomy is a surgical procedure that bypasses the bladder and connects the ureter from the kidneys to an opening (stoma) in the skin to drain urine.
- This is often necessary when the bladder is inoperable due to cancer, an accident, or a birth defect.
- A pouch is attached to the outside of the body to collect urine, and it needs to be emptied and changed at regular intervals.
- It is very important to keep the stoma and the skin around it clean and dry**.
- If you notice any unusual symptoms such as skin redness, sores, changes in urine, or fever, inform your doctor immediately.
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