A urostomy is created by surgically opening up the abdominal wall through which urine passes. A urostomy is performed when the bladder is either no longer working, not working properly, or has to be removed. There are several types of these surgeries, but the most common is the ileal conduit.

The part of the urostomy that you see is called the stoma. A stoma is typically positioned around the abdomen. The stoma is where the urine will now leave the body and protrudes from the skin's surface approximately 1 inch.

Ileal and Colonic Conduit is when the surgeon takes a 6 to 8 in piece of the small bowel and makes it into a pipeline for the urine. It is similar to splicing a hose. The tubes that carry urine from each kidney to the bladder (ureters) are removed and joined to the small bowel. One end of the small bowel is sewn closed, while the other end is brought through an opening on the abdomen (stoma). The ileal and colonic conduits are the most common urostomies.

In a Continent Urostomy, there are two main continent alternatives to the ileal or cecal conduit (others exist). In both the Indiana and Kock pouch versions, a reservoir or pouch is created inside the abdomen using a portion of either the small or large bowel. A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted several times daily to drain urine from the reservoir.

An Indiana Pouch urostomy is when the ileocecal valve that is normally between the large and small intestines is relocated and used to provide continence for the pouch which is made from the large intestine. With a Kock pouch version, similar to that used as an ileostomy alternative, the pouch and a special "nipple" valve are both made from the small intestine. In both procedures, the valve is located at the pouch outlet to hold the urine until the catheter is used.

An Orthotopic Neobladder urostomy is when a replacement bladder made from a section of intestine substitutes for the bladder in its normal place and is connected to the urethra to allow voiding through normal urination. Like the ileoanal reservoir, this is technically not an ostomy because there is no stoma. Candidates for neobladder surgery are individuals who need to have the bladder removed but do not need to have the urinary sphincter muscle removed.

Urostomies are done to alleviate or cure symptoms of a disease or an existing condition. Doctors will recommend a urostomy for several reasons. Some of the reasons are:

• Bladder Cancer
• Spinal Cord Injuries
• Malfunction of the Bladder
• Birth Defects
• Spina Bifida

Stomas are typically round but aren’t perfectly round in shape. Stomas vary in color and are generally shades of red and pink, and are fleshy and moist. They greatly vary in size (circumference). The stoma has no nerve endings, so it will not hurt when touched. You may see the stoma move slightly. This is completely normal. It is just part of the process your body is doing to help drain the urine into the pouch. If you or your healthcare provider note a stomal color of brown, purple or black (especially black), your surgeon must be notified at once. A change in color may mean that the pouching appliance may be on too tight, or an internal problem is present. Any color other than red or pink may indicate that the stoma is not perfused, which may result in death. No matter the reason for the change in stoma color, be sure to call the surgeon. The flow of urine cannot be controlled because there are no muscles in the stoma. The urine will typically drain on a constant basis since there is no storage (bladder) to hold the urine.

The frequency of the output of the stoma is affected by liquid intake. Medication and treatment prescribed by your doctor also have an affect on the stoma output. The stoma can also bleed slightly when releasing urine. However, if your urine becomes cloudy, bad smelling or bloody, you should contact your doctor immediately.

There are many different types of stomas as well, some of which include:

Normal Stomas

• Protruding stomas protrude from the abdomen skin's surface. There is no difference if the abdomen is fleshy or flat. The protrusion varies in length and can slightly retract or extend throughout the life of the urostomy.
• Flush stomas are flush with the skin's surface. The best way to deal with this type of stoma is to use a wafer system that has convexity. This will help the stoma stand out more against the skin so that a better seal will form.
• Retracting stomas are pulled inward from the skin's surface. These types of stomas require a wafer system that has a high convexity. This helps the stoma stand out more against the skin and create a better seal and reduce irritation.

Challenging Stomas

• Prolapsed stomas are usually found in overweight patients or patients with weak abdominal muscles. These types of stomas continually protrude 1 to 4 inches as time goes on. The treatment for a prolapsed stoma is to use a flat and flexible pouching system. This will prevent trauma to the stoma when pouching. Use of a support belt can prevent trauma and prevent the stoma from protruding further.
• Parastomal stomas occur because of weak muscle in the abdominal wall that allows the intestine to come through the muscle, especially if the stoma is placed just outside of the rectus abdominus muscle. This can be prevented by wearing an abdominal support belt when lifting or exercising. A one-piece pouching system or a two-piece adhesive system helps adapt to any irregular contours of the skin and/or stoma.
• Mucocutaneous Separation occurs when the sewn intersection between the stoma and the skin separates. This often occurs when you contract an infection or there is too much tension on the sewn stitch. If this occurs, call your physician. A wound care product can be used to absorb drainage and prevent excess soiling of separation from stool or urine.
• Stomal Necrosis occurs when there is impaired or restricted blood flow to the stoma. Talk to your doctor if this happens. The stoma will slough off and a urostomy deodorizer will be used while the necrotic stoma is sloughing off.

• Two-Pouch Systems allow changing pouches while leaving the barrier/wafer attached to the skin. The wafer/barrier is part of a "flange" unit. The pouches include a closing ring that attaches mechanically to a mating piece on the flange. A common connection mechanism consists of a pressure fit snap ring, similar to that used in Tupperware™.
• One-Pouch Systems consist of a skin barrier/wafer and pouch joined together as a single unit. One-pouch systems are simpler than two-piece systems but require replacing the entire unit, including the skin barrier, every time the pouch is changed.

Irrigation System
These are the major types of urostomy systems. There are also a number of styles. Keep in mind, there is no right or wrong choice when it comes to urostomy systems. Each person must find the system that performs best for him or her. For instance, there are flat wafers and convex-shaped ones. There are fairly rigid and very flexible ones. There are barriers with and without adhesive backing and with and without a perimeter of tape. Some manufacturers have introduced drainable pouches with a built-in tail closure that doesn't require a separate clip. 

The decision as to what particular type of system best fits is a personal one geared to each individual's needs. It is not uncommon to try several types until the best solution is found. There is no reason to stay with a poorly performing or uncomfortable pouching system.

• Work: With the possible exception of jobs that require heavy lifting, a urostomy should not interfere with work at all. People with urostomies are successful business people, teachers, doctors, writers, etc.
• Sex and social life: Physically, the creation of a urostomy shouldn’t affect sexual function. If there is an issue, it almost always relates to the removal of the rectum. In females, the position and structure of the vagina may feel slightly different. It is best to be open with your partner of how you are feeling. The urostomy itself should not interfere with normal sexual activity or pregnancy. It does not prevent one from dating, marriage or even having children.
• Clothing: Usually, you are able to wear the same clothing as before surgery, including swimwear.
• Sports and activities: With a securely attached and properly fitted pouch, you can swim, go camping, play baseball and participate in practically any type of sport. Caution should be taken in activities with heavy body contact. Special small pouches can be used if swimming or playing sports is desired. If you spend time in a sauna or hot tub, the heat may loosen the barrier. Be sure to always check for a proper seal.
• Travel is not restricted in any way. Just remember to pack all of your ostomy supplies for the trip. Always keep your supplies where you can easily reach them.
• Bathing and showering may be done with or without the pouch in place. If you shower/bathe with your pouch off, make sure that you choose a soap that is oil and residue free. These types of soaps will not affect the adhesive the urostomy system uses.
• Diet: Unless your doctor has prescribed you a specific diet, there should be no diet restrictions and foods can be enjoyed as before. It is best to drink at least 8-10 glasses of water per day to help decrease the chance of kidney infection.
• Urinary Tract Infections: UTIs can still occur with a urostomy. Some of the signs and symptoms to look out for are: blood in the urine, increased mucus in the urine, cloudy and strong smelling urine, fever, loss of appetite, confusion, back pain and nausea/vomiting.

There are very important things to remember when caring for your urostomy.

• Empty your pouch frequently. Never allow the output to reach a certain point (1/3 or ½ full) in the collection bag. A full pouch becomes heavy and may break loose from the skin. A full pouch is also more difficult to drain.
• Replace your entire pouching system at least 3 times per week. For children and infants, the pouching system needs to be changed more frequently.
• Plan on changing your pouch in the morning before your urostomy becomes too active.
• Always care for your skin by using a clean washcloth or wipe, and soap with no oils, fragrances and dyes.
• Make sure your skin is completely dry. Constantly check for any color changes or visible signs of irritation.
• Be sure that you have a Urostomy System in place that fits securely and comfortably.
• For additional information contact your physician.