If you are facing a condition where your bladder cannot function properly due to cancer, injury, or a congenital condition, you may encounter challenges in passing urine normally. In such cases, your body requires an alternative way to drain urine; otherwise, you risk kidney damage. One solution your doctor may recommend is a procedure known as a Ureterostomy. While the name may sound complex, let’s break it down simply.
What exactly is a Ureterostomy?
Simply put, this is a surgical procedure. It involves disconnecting the ureters (the tubes that carry urine from your kidneys to the bladder) and redirecting them to a small opening made on the surface of your abdomen. In medical terms, this opening is called a stoma.
Think of it like a plumbing system: if one part is blocked, we create a new path to get the fluid out. After this surgery, your urine bypasses the bladder and flows directly from the kidneys through the stoma to the outside of your body. To collect this urine, you will use a special pouch attached to the stoma, which you can empty as it fills up.
Typically, this is performed as a permanent solution. Depending on your needs, your surgeon may connect one or both ureters to the stoma.
Why is this surgery necessary?
Your doctor might suggest this procedure for several reasons, primarily when the bladder is unable to perform its function effectively.
- Bladder removal (Cystectomy): You may need your bladder completely removed due to conditions like bladder cancer.
- Bladder damage: If the bladder is severely damaged by injury or other medical conditions, it may no longer function as intended.
- Congenital Anomalies: Conditions present from birth, such as Spina Bifida, can impair bladder function.
- Spinal Cord Injury: Damage to the spinal cord can disrupt the nerves that control the bladder, leading to urinary difficulties.
Retaining urine in the body due to these issues is dangerous. It can lead to frequent Urinary Tract Infections (UTIs) and potentially lead to kidney failure over time. This surgery helps minimize those risks.
What tests are performed before surgery?
Before proceeding, your medical team will conduct several tests to evaluate your overall health.
| Test Name | What it checks |
|---|---|
| Kidney function tests | To assess how effectively your kidneys are working. |
| Blood tests | To evaluate your general health and check for signs of infection. |
| Imaging tests (X-ray, Ultrasound) | To visualize the structure and position of your kidneys, ureters, and bladder. |
| Retrograde pyelogram | A dye is used with X-rays to identify any blockages in the urinary tract. |
| CT scan | To provide detailed cross-sectional images of your body. |
| MRI | To get highly detailed images of the kidneys and ureters. |
Furthermore, before surgery, a doctor or a specialized stoma nurse will work with you to choose the best site for your stoma. It needs to be a place that is easily visible to you and does not interfere with your clothing, such as where your belt sits.
Life after surgery and stoma care
After surgery, you will need to adjust to a new routine, but it is not as difficult as it might seem.
How the stoma and pouch work
The stoma is not a muscle, so it cannot control the flow of urine. Urine will drip out continuously.
- Pouching System: This consists of two parts: the skin barrier, which attaches to your skin, and the pouch that collects the urine. Sometimes these come as a single unit.
- Skin Barrier: This is a square sticker-like piece with a hole to fit the stoma. Its specialized adhesive keeps it securely attached to the skin and prevents leaks.
- Urine Pouch: This attaches to the barrier to collect the urine.
You should empty the pouch when it is one-third to half full. You can do this without removing the pouch by opening the valve at the bottom into the toilet. At night, you can attach a night drainage bag to the valve for convenience. Because these bags sit close to the body, they are usually not noticeable under normal clothing.
Caring for your stoma and surrounding skin
Keeping the stoma and the surrounding skin clean and dry is essential.
- Clean the stoma and surrounding skin daily using mild soap and water.
- Rinse thoroughly to remove all soap residue.
- Dry the area completely; moisture should be avoided.
You will typically need to change the pouching system every 5-7 days. Your healthcare team will provide you with thorough instructions on how to manage this.
When to contact your doctor
Stay attentive to your stoma and the surrounding skin. If you notice any changes, contact your doctor immediately.
| Warning Signs | Description |
|---|---|
| Skin Issues | |
| Redness or rash | Redness, itching, or a rash around the stoma. |
| Skin breakdown | Dry, cracked, or scabbed skin. |
| Signs of Infection | |
| Urine changes | Urine that is dark in color, blood-tinged, or has a strong, foul odor. |
| Other symptoms | Back pain, fever, nausea, vomiting, or loss of appetite. |
Take-Home Message
- A ureterostomy is a surgical procedure to divert urine from the body when the bladder cannot function properly.
- Urine is redirected from the kidneys to an external stoma and collected in a special pouch.
- Keeping the stoma and surrounding skin clean is vital to prevent infections and skin irritation.
- Contact your doctor immediately if you experience a fever, changes in urine, or skin irritation.
- While this surgery is a life-changing adjustment, it helps protect your kidneys from severe damage and supports a healthier life.
Ureterostomy, stoma, urinary bag, bladder surgery, kidney disease, UTIs, urinary diversion surgery, ostomy
