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Urostomy

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Urinary diversion is a general term applied when the bladder is removed or the normal urinary structures are being bypassed. A surgical opening that creates a stoma is made in the urinary system to move urine flow away from the bladder. There are several surgical procedures to divert urine including the ileal conduit, ureterostomy (stoma created using a ureter), and continent urostomy (internal pouch).

Indications:

  • cancer
  • congenital malformation
  • paralysis
  • ureteral stricture
  • chronic urinary tract
  • infectious spina bifida
  • trauma
  • neurogenic bladder

Ileal Conduit

This is the most common type of surgical urinary diversion. A 6” segment of the ileum (small bowel) is separated from the small bowel with the blood supply intact. One end of the segment is sutured closed, and the other end of the segment is brought out of the abdomen and a stoma is created. The ureters are implanted into this ileal segment. This serves as a passageway (conduit) for the urine. The bladder is removed.

Reproduced with permission from Registered Nurses’ Association of Ontario. (2009) Ostomy Care and Management. Toronto, Canada. Registered Nurses’ Association of Ontario.

Discharge:

  • urine, which may be pink with blood initially
  • continuous drainage following surgery
  • some mucous shreds in the urine

Continent Urostomy

With this procedure, an internal pouch (reconstructed bladder)

is constructed using the end of the ileum (small bowel) the cecum and ascending colon (first two segments of the large bowel).

The two ureters (tubes from the kidneys) are implanted into the pouch. The ileum is brought to the skin surface as a stoma. Urine does not leak out of the stoma as the valve between the large and small bowel (ileocecal valve) is used during the construction of the pouch.

This type of urostomy is sometimes called an “Indiana” or “Miami” pouch.

Indications:

  • as above for urostomy

Discharge:

  • The internal pouch is drained regularly by inserting a catheter through the external stoma. Urine with some mucous is expected.

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