Has your doctor told you about a urostomy? Or is someone you know about to have this surgery? It's normal to feel a little scared and anxious when you hear this name. "What kind of thing is this?", "What will my life be like after this?" Many questions arise in your mind. But when we know exactly about this, that fear disappears. Today, we will talk about everything very simply, in a way that you can understand.
What exactly is a Urostomy?
Simply put, a urostomy is a surgical procedure that creates a new path for urine (pee) to exit your body. In this procedure, the surgeon creates a small opening, or hole, in your abdomen that is exposed to the skin. In medical terms, this is called a stoma .
Think of our urinary system as a water pipe system. Urine produced by the kidneys travels down two tubes (ureters) to the bladder, where it is then expelled from the body through another tube (urethra). Sometimes, the main tank of this system (the bladder) or the tubes connected to it become damaged due to illness or accident. Then, another route must be created to allow urine to exit the body. That is why this surgery is performed.
Urine continues to flow out of the body through this stoma. A special bag (urostomy bag) is used to collect the urine that comes out, and is attached to the stoma. This is usually a permanent surgery. This means that it cannot be reversed. But don't worry, your medical team will help you adjust to your daily life with this new change.
Why is it necessary to have this kind of surgery?
There are several reasons why someone might need a urostomy. The main reasons include:
- Bladder removal due to bladder cancer: This is the most common reason. When the bladder is completely removed (cystectomy) due to cancer, this procedure is used because there is no place for urine to collect.
- Bladder damage: When the bladder is severely damaged due to an accident, illness, or radiation treatment.
- Urinary incontinence: In severe cases, there is no way to control urine.
- Spinal cord damage: When bladder function is lost due to spinal cord injuries.
- Congenital disorders: Birth defects such as spina bifida.
- Damage to the urethra: When the tube that carries urine out of the body is damaged.
- Other abnormalities of the urinary system: Other problems that prevent urine from being released properly.
In summary, this surgery is a solution to make life easier and safer in any serious situation where urine cannot be excreted from the body normally.
Are there types of urostomy surgery?
Yes, there are several main methods of performing this surgery. It depends on your medical condition and the surgeon's conclusion.
Ileal conduit - This is the most common method.
In this procedure, the surgeon removes a small piece of the last part of your small intestine (ileum) . Then, a small tube-like channel is created from the piece. The two tubes that carry urine from the kidneys (ureters) are connected to this newly created channel. The other end of the channel is connected to a stoma (stoma) created in the abdomen. Urine from the kidneys then flows out of the stoma through this new channel. The stoma is usually located on the right side of the abdomen.
Colonic conduit
This is very similar to the previous method, except that instead of taking a section of the small intestine to create the new channel, a section of the large intestine (sigmoid colon) is used.
Ureterostomy
In this procedure, no part of the intestines is removed. The doctor connects one or both tubes that carry urine from the kidneys directly to the stoma created in the abdomen .
How do you prepare before surgery?
Before the surgery, your surgeon and the medical team will talk to you carefully. They will explain the following to you:
- Why do you need this surgery?
- What happens during the surgery?
- What to expect after surgery?
- What are the risks associated with this?
You will be advised to fast, that is, abstain from food and drink, for a period of time before the surgery. They will also tell you whether you should stop taking any medications you normally take or continue taking them. It is very important to tell your doctor about all the medications you are taking, including vitamins and herbal remedies.
In addition, before surgery, the doctor and nurses will talk with you to choose the best place on your stomach to create the stoma. This should be a place that you can easily see, reach, and have a flat surface. This will make it easier for you to change the bag later.
What happens during and after the surgery?
The surgery is performed under general anesthesia. This means you will not feel anything, you will be completely asleep. The surgery can take about 6 hours. The surgeon will create a stoma in a pre-selected location and connect a tube to it to carry urine. Sometimes, in cases such as cancer, it may be necessary to remove other organs such as the bladder, lymph nodes, or parts of the reproductive system (prostate in men, uterus in women).
After the surgery, you will be taken to a recovery unit and transferred to a ward when your condition stabilizes.
- One or more tubes (drains) may be placed to remove fluid that accumulates in the body.
- Medication is given to control the pain.
- To prevent blood clots and pneumonia, you are encouraged to sit up in bed as soon as possible, move your legs, and walk with someone's help.
- You can start eating and drinking normally in a few days.
| Risk type | Description |
|---|---|
| Common risks associated with surgery | Problems related to anesthesia, infections, damage to surrounding organs, blood clots, excessive bleeding, pneumonia. |
| Possible complications later | Blockage of the tube due to scar tissue, infections or wounds of the skin around the stoma, hernia formation, kidney stones or kidney failure, metabolic issues. |
As with any surgery, there are some risks involved. But it is generally a very safe procedure. Your doctor will do everything he can to minimize these risks.
How long will it take to recover? When should I see a doctor?
Some people leave the hospital within three days of surgery, while others may need to stay for a week or more. While you are in the hospital, the nursing staff will teach you how to keep your stoma clean, how to use the pouch, and how to change it. This is something new, so it may feel a little strange at first, but you will get used to it after a while.
After you return home, it may take about two months to fully recover before you can return to work or school. During this time, you will have the opportunity to get used to using your urostomy bag.
If you have any problems, call your doctor right away, especially if you have any of these symptoms:
- Fever
- Abnormal bleeding
- Severe pain
- Difficulty using the urostomy bag
- Change in urine color or odor
A few questions on everyone's mind
When talking about this type of surgery, many people have similar questions. Let's find answers to those as well.
What does a stoma look like? How does it feel?
When you first see your stoma, it may be slightly swollen, red, and bruised. But don't worry, this will change over time. The stoma will gradually shrink and turn a light pink or red color. It may be round or oval in shape. Some people's stoma may be slightly raised above the skin, while others may be flat against the skin.
The most important thing is that the stoma has no nerve endings. This means that you cannot feel it. Although the surrounding skin may be sore until the surgical wound heals, you will not feel anything when you touch the stoma.
How often should the urostomy bag be changed?
There are two things here: emptying the bag and changing the bag.
- Emptying: You will need to empty the bag as often as you went to the bathroom before surgery. Usually every few hours. Don't wait until the bag is completely full. It's best to empty it when it's about a third or half full. This will help prevent the bag from leaking and causing skin infections.
- Changing: The changing time varies depending on the type of bag system you use. Some need to be changed daily. Other types can be used for three days or as little as a week.
The good news is that there is a large drainage container that you can attach to your urostomy bag when you go to bed at night, so you can sleep soundly all night without getting up.
How do you adjust to this new change?
It may take some time to get used to living with this change in your body. This is very normal. At first, you may feel sad, angry, or scared. You may worry about what other people will think about this.
Talk to your doctor, family, and close friends about these feelings. There are also support groups for people who have had this type of surgery. They can understand your experience very well. You can learn a lot from their experiences and gain strength.
Take-Home Message
- A urostomy is nothing to be afraid of. It is a safe surgery that can make your life easier, and often save your life.
- It will take time to get used to this new body change. It's normal to feel sad and scared about it. Talk to someone you trust about these feelings.
- Keeping the stoma and the skin around it clean and dry is very important to prevent problems.
- Never hesitate to talk to your doctor about any minor problem or issue you may have.
- You can still live a normal, active, and happy life after urostomy surgery.
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