What is a Urostomy?

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.

Types of Urostomies

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.

Reasons for a Urostomy

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

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

Urostomy Stomas

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

Normal Stomas

• Protruding stomas protrude from the abdomen's surface. There is no difference in the stoma based on whether 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, which helps the stoma to stand out more against the skin so that a better seal will form.
• Retracting stomas are pulled inward from the skin$#39;s surface. These types of stomas require a wafer system that has a high convexity in order to help the stoma stand out more against the skin and create a better seal to reduce irritation.

Challenging Stomas

• Prolapsed stomas are usually found in overweight patients or patients with weak abdominal muscles. These types of stomas continually protrude from one to four inches above the skin's surface, with continued protrusion possible over time. The treatment for a prolapsed stoma is to use a flat and flexible pouching system, which 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, particularly 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 if there is too much tension on the sewn stitch. If this occurs, call your physician immediately. Wound care urostomy supplies 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. If this happens, you should contact your doctor immediately to ensure proper urostomy care. Under a physician's care, the necrotic stoma will slough off and a urostomy deodorizer can be used for sanitation and privacy.

Urostomy System Products
Pouching systems
Urostomates can use either one-piece or two-piece pouching systems. These systems contain a special valve or spout that adapts to either a leg bag or to a night drain tube connected to a special drainable bag or bottle.

• Two-Pouch Systems allow you to change pouches while leaving the "flange" unit in place, attached to the skin for up to five days. The flange unit consists of a wafer/skin barrier attached to the skin around the stoma with an adhesive. 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 the skin barrier/wafer and pouch joined together as a single unit. One-pouch systems are simpler than two-piece systems, but require users to replace the entire unit, including the skin barrier, each time that the pouch is changed.



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.

Irrigation System
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.

Life after a Urostomy

• Work: With the possible exception of jobs that require heavy lifting, urostomy care should not interfere with work at all. People with urostomies are successful business people, teachers, doctors, writers, etc.
• Sex and social life: Physically, a urostomy shouldn't affect sexual function or interfere with normal sexual activity or pregnancy. It does not prevent one from dating, getting married, or even having children. 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. Although it can be difficult, it is always best to be open with your partner about how you are feeling, both physically and emotionally.
• Clothing: In most cases, urostomates 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 or high-heat situations. If you spend time in a sauna or hot tub, the heat may loosen the adhesive barrier, so one should continuously check for a proper seal. A special line of urostomy supplies, including small pouches, are designed for use during swimming and other sports participation.
• Travel is not restricted in any way. Just remember to pack all of your urostomy supplies, with back-ups, for the trip. During travel, 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 used by your urostomy system.
• 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 stay hydrated and help decrease the chance of kidney infection.
• Urinary Tract Infections: UTIs can still occur in males and females 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. If you see signs of a UTI, contact your doctor.

Urostomy Care

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

• Proper urostomy care includes emptying your pouch frequently. Never allow the output to reach a certain point (one-third to half full) in the collection bag. A full pouch becomes heavy and may pull on or break loose from the skin. A full pouch is also more difficult to drain.
• A one-piece urostomy pouch needs to be replaced every time it is drained. Two-piece pouch systems should be replaced at least three 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. Urostomy care becomes more manageable if you are able to stick to a changing and cleaning routine or schedule.
• Always care for your skin by using a clean washcloth or wipe, and soap with no oils, fragrances or dyes. You should clean your stoma at least once a day, or every time you replace the urostomy system.
• When applying a new urostomy system, make sure your skin is completely dry. Constantly check your stoma and the surrounding skin area for any color changes or visible signs of irritation..
• Be sure that you have a urostomy system in place that fits securely and comfortably, and that you find the system that is right for you.
• When in doubt, contact your physician.

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 1-866-643-0956 with any questions, or simply to speak with a representative today.

*Co-payments, deductibles and conditions apply.