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A urostomy is a surgically created opening in 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 called the ileal conduit. Following an ileal conduit or other urostomy-related surgery, there are a variety of important urostomy care procedures to become familiar with, and urostomy supplies one will need in order to help manage their condition.
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 one inch. The majority of urostomy supplies are designed to attach to the body around the stoma, to help drain urine as discreetly and comfortably as possible.
Ileal and Colonic Conduit is when the surgeon takes a six- to eight-inch 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 (the stoma). The ileal and colonic conduits are the most common types of urostomies.
A Continent urostomy is when a segment of the small or large bowel is used to create an artificial bladder, which can then be drained by an intermittent catheter as needed. The Indiana and Kock pouch versions of continent urostomy are the two most common methods, where a reservoir or pouch is created inside the abdomen, 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 is substituted 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. Because of their internal nature, Orthotopic Neobladder urostomies typically require fewer urostomy supplies than ostomies with stomas, but there are still lifestyle changes that should be made to ensure proper health following this type of surgery.
Urostomies are done to alleviate or cure symptoms of a disease or an existing condition. Doctors will recommend a urostomy for several reasons, including:
Stomas are typically round, but not perfectly circular in shape. Stomas are fleshy and moist, and can greatly vary in circumference. The stoma has no nerve endings, so it will not hurt when touched. It is normal for the stoma to move slightly at times, as a part of your body's process to help drain the urine into the pouch. Because the stoma has natural outward contractions, there is little danger of water entering the stoma, and most urostomates can shower and bathe normally.
Stomas can vary in color to some degree, but should generally be shades of red or pink. If you or your healthcare provider notice a stomal color of brown, purple, or especially black, you should notify your surgeon immediately. A change in color may mean that the pouching appliance may be on too tight or that an internal problem is present, and a surgeon should be informed regardless of the suspected reason for the color change. Any color other than red or pink may indicate that the stoma is not perfused, which may result in death.
The flow of urine due to a urostomy cannot be controlled because there are no muscles in the stoma, which is why attention to proper urostomy care must be kept in mind at all times. Since there is no bladder to hold the urine, it will typically drain on a constant basis. The frequency of the output of the stoma is affected by liquid intake, and certain medications and treatment plans prescribed by your doctor that can also affect the stoma output. It is normal for the stoma to bleed slightly when releasing urine or when changing your urostomy supplies. However, if your urine becomes cloudy, bad-smelling, or bloody, you should contact your doctor immediately.
Types of Stomas
As well as choosing between one-piece or two-piece pouch systems, urostomates also have a choice between additional details. Wafers can be flat or convex-shaped. Wafers, tubing, and pouches come in a range of more flexible or more rigid materials. There are barriers with and without adhesive backing, and with or without a perimeter of tape. Some manufacturers have introduced drainable pouches with a built-in tail closure that doesn't require a separate clip.
In addition to the pouching systems, your urostomy care routine should also include irrigation of your urostomy products. Urostomy irrigation can be done at the same time as you drain your urostomy pouches to allow for convenient cleaning. Irrigation kits typically contain some sort of funnel to make it easy to irrigate any tubing, pouches, or drainable bottles. Using an irrigation kit, you should rinse through all of your urostomy supplies using a mild soap, followed by a mixture of vinegar and warm water, and finally rinse thoroughly with warm water and allow to dry. Many irrigation kits also come with a special cleaning solution.
There are a few very important things to remember when caring for your urostomy.
Keep in mind, there is no right or wrong choice when it comes to urostomy systems. Some urostomy supplies and care systems are better suited for certain lifestyles, and each urostomate must find the system that performs best for him or her. It is not uncommon to try several types of urostomy systems until the best solution is found to fit your individual needs. And most importantly, there is no reason to stay with a poorly performing or uncomfortable pouching system.
Liberator Medical is committed to providing you with the best urostomy supplies and support to help you care for your urostomy. We offer an extensive selection of the best urostomy supplies, and fast, discreet delivery to ensure your privacy and convenience. And, through Liberator Medical's Ostomy Supply-Care Program*, our Supply-Care Specialists will work directly with your physician and/or insurance company to make sure you get the care you deserve. We know that adjusting to life with a urostomy can be difficult, but living with one doesn't have to be.
Contact Liberator Medical at 1-866-642-6140 with any questions, or simply to speak with a representative today.
*Co-payments, deductibles and conditions apply.