A urostomy is an opening in the abdominal wall that a surgeon creates during surgery. It allows urine to bypass an injured or impaired bladder and exit the body.

A person may require a urostomy as a result of bladder cancer or other problems affecting the bladder.

This article reviews what a urostomy is, the different types, why a person may need it, and more.

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A urostomy is an opening in the abdomen created during surgery.

According to the American Cancer Society (ACS), a urostomy directs urine away from the bladder, allowing it to pass out of the body, typically through an opening called a stoma. A surgeon usually creates a stoma on the belly.

The stoma will be moist and shiny, and round or oval in shape. As there are no nerve endings, a stoma itself will not cause any pain or discomfort.

A person will not be able to stop the urine from exiting the stoma, so they will require a pouch to collect the urine.

A standard or conventional urostomy — also called incontinent diversion — uses an ileal conduit to collect urine. An ileal conduit is a pouch that a surgeon creates using a small part of the small intestine.

A surgeon will perform the following steps to create an ileal conduit:

  1. They will remove 6–8 inches of a part of the small intestine called the ileum.
  2. They will then connect the rest of the ileum to the large intestine.
  3. The next step involves detaching the ureters from the bladder and attaching them to the part of the ileum that they removed.
  4. Then, they will attach one end of the piece of the ileum to the front of the abdominal wall and form a stoma.
  5. They sew the other end closed to make a pouch that holds the urine inside the body.

The surgeon may or may not remove the bladder during this procedure. A person will need to wear a collection pouch to collect the urine.

Continent diversion also involves the creation of a pouch. However, unlike incontinent diversion, the pouch has two valves and is only internal.

One valve prevents urine from backing up into the kidneys. The second valve keeps the urine in the pouch until a person places a catheter in the stoma to remove it.

A person needs to empty the pouch with a catheter (small plastic tubing) about four or five times per day.

There are different types of pouches, which include:

  • Kock pouch: A surgeon will create the pouch, valves, and outlet using the end of the small intestine.
  • Indiana pouch: A surgeon will make the pouch from the large intestine and the outlet from the small intestine. They will use the ileocecal valve, which is naturally present at the junction between the small intestine and the colon.
  • Mitrofanoff procedure: They will make the pouch from the bladder, large or small intestines, or a combination of both. They will use the appendix, fallopian tube, or a part of the ureter to make the outlet.
  • Ileal neobladder: They will create a pouch from the small intestine and connect it to the urethra so it exits the body normally. However, a person will require a schedule, as they will not experience the urge to urinate.

A person may need a urostomy if their bladder is damaged or has been removed.

Some factors or conditions that may require a urostomy include:

Other reasons a person may need a urostomy include spinal cord injury and chronic bladder infection.

Some children may need a urostomy due to a congenital anomaly that causes a urinary tract issue in which urine backs up into the kidneys.

Children may also need a urostomy if they are born with spina bifida. This is when the spine and spinal cord do not develop as they should, causing the spinal cord to be exposed and unprotected.

Before the procedure, a person should follow all instructions from the doctor, surgeon, or treatment team.

They will provide specific guidance on how to prepare, including when to stop eating and drinking, what medications to take and when, where to go for the procedure, and so on.

In some cases, a treatment team will work with a person to fit possible collection pouches. This helps ensure the flattest fit and good placement of the bag.

During surgery

Once a person arrives at the facility, the surgical team will begin preparations. Part of the preparation will include examining the abdomen for the best location to make the stoma.

When the surgical team is ready, the person will receive a dose of general anesthesia before the doctor makes an incision and proceeds with the surgery.

During a person’s time in the hospital, a healthcare professional will show them how to care for their pouch system and stoma.

Following their hospital stay, a person will continue healing at home. It can take about 6–8 weeks for the stoma to reach its final size. During this time, it will slowly shrink.

A person should speak with the healthcare team about when they can return to their normal activities.

They will have a general schedule indicating when a person can resume specific activities, such as exercise, work, school, and sex.

A person will also likely need to schedule a follow-up appointment with a doctor. During this visit, the doctor will review how the person’s recovery is going and check for signs of infection or other issues.

The healthcare team will review how a person should take care of their bag and stoma at home.

They may provide in-person instructions in the hospital and send a person home with instructions as well. A person should follow their instructions when caring for the stoma and bag.

Emptying the pouch

In most cases, a person should empty the pouch when it is between one-third and half full. This may be every 2–4 hours.

Most seals stay intact for 3–7 days. When the seal breaks, a new pouch is needed.

Changing the pouch

A person will likely need to change the pouch itself every few days, depending on the brand used. Some require daily changing, and others need to be changed every 3 days.

A person can use tape or a specialized belt to help keep the bag in place. Which method a person uses is a matter of personal preference.

Stoma care

A person can help protect the skin around the stoma by:

  • ensuring they have the right size pouch
  • changing the pouching system regularly
  • cleaning the skin using water and patting it dry
  • watching for sensitivities, irritation, and allergies

People may also need to shave underneath the pouch to help the barrier stick well.

If a person notices spots of blood, they should not be concerned. The skin around the stoma can be delicate, and cleaning around the stoma can disturb it and cause minor bleeding.

However, if bleeding does not stop quickly, a person should call a doctor or ostomy nurse.

Urostomy bags should fit securely and discreetly under clothing. There are several different brands and fits, so a person should work with a nurse or member of their care team to find the bag that works best for them.

The urostomy bagging system should not interfere with a person’s life. The following are some things a person should keep in mind when living with a urostomy bag:

  • Work: It should not affect a person’s work, with the possible exception of lifting heavy objects.
  • Social and sex life: They can maintain their usual social interactions, date, conceive, and engage in sexual activities.
  • Clothing: They can wear the same clothes they wore before the surgery.
  • Diet: While no specific diets make a difference, some experts suggest drinking 8–10 glasses of water to help prevent kidney problems.
  • Sports and activities: They can shower with or without the pouch, travel without restrictions, and participate in most sports, though they may want to use caution when playing a full-contact sport.
  • Sleep: They can use a night drainage system, which collects more urine and allows a person to get uninterrupted sleep.

The ACS recommends that people connect with others who have gone through the procedure through an ostomy patient visiting program.

The program matches a person with a volunteer from the United Ostomy Association of America who has adapted to life with their ostomy. It allows someone to ask questions, address concerns, and find general support prior to their procedure.

A person can find support groups by speaking with a nurse or doctor. They can also use the United Ostomy Associations of America’s website to find them.

The Wound, Ostomy, and Continence Nurses Society (WOCN) can help to find a wound, ostomy, and continence nurse.

The overall cost of a urostomy can include the cost of the procedure itself as well as the medical equipment needed to care for and replace the bagging systems.

Most private insurance plans and Medicare Part B cover the costs of the procedure and equipment. How much coverage a person can get may vary by plan.

Even with insurance, a person may still need to pay their full deductible as well as copays and other fees associated with the care.

The ConvaTec Great Comebacks Community can help connect people with low cost supplies. A person can also ask a pharmacist or doctor’s office for information on organizations that may help cover the costs of ongoing care.

A person should speak with a doctor if they have:

  • bleeding around the stoma that does not stop quickly
  • signs of infection, such as a UTI or skin infection
  • a reaction around the stoma, such as a rash
  • a hernia

A person may want to visit a doctor for other reasons. Often, a nurse or other staff member can help answer questions and provide support.

The following sections provide answers to frequently asked questions about urostomies.

How does a urostomy differ from a ureterostomy?

A ureterostomy is a type of urostomy. In a ureterostomy, the surgeon attaches the ureter directly to the stoma and does not use any internal pouch or conduit, as with other urostomy types.

How does a urostomy differ from a urethrostomy?

Both are surgical procedures to divert urine. However, in a urethrostomy, a surgeon creates an opening in the urethra.

How does a urostomy differ from a colostomy?

While a urostomy involves bypassing the bladder, a colostomy involves bypassing a part of the colon.

A surgeon detaches a part of the colon to bypass a damaged section of the colon. They attach a bag to the abdomen to collect feces.

A urostomy is a procedure where a surgeon creates a stoma in the abdomen and diverts urine away from the bladder. The urine passes through the stoma and into a pouch that a person then empties as needed.

A person will need time to recover from the procedure, but once they do, they can resume their normal activities. They will need to replace supplies regularly and take care of their stoma.

People who need support can contact different organizations. These groups may be able to provide financial or emotional support to those living with urostomies.