A urostomy is a surgical procedure that can be a part of bladder cancer treatment. You may also need a urostomy if your bladder isn’t functional due to other cancers or cancer treatment.
We spoke with reconstructive oncologist Ouida Westney, M.D., about what patients can expect after a urostomy.
What is a urostomy?
A urostomy is a type of surgery that creates an opening, or stoma, in the abdomen. This allows urine to exit the body without involving the bladder.
Are there different types of urostomies?
There are two types of urostomies: incontinent and continent. The difference between the two is what bridges the gap between the ureters and the stoma.
Incontinent urostomies use an appliance to collect urine. An incontinent stoma is usually part of an ileal conduit, which uses part of the small or large intestine to connect the ureters to the skin.
A continent stoma is connected to a continent pouch, also made from the intestine, which stores urine. A continent stoma must be catheterized every 4 to 6 hours to empty the pouch. It functions more like a native bladder, but the urine exits through the stoma rather than the urethra.
“Patients can usually choose which kind of stoma they prefer,” says Westney. “But in some cases, such as locally advanced cancer or an urgent problem that arises during surgery, it may not be possible to do the more complex continent diversions.”
Which cancer patients may benefit from or need a urostomy?
“When cancer either originates in the bladder or has extended to the bladder, the bladder may need to be removed,” says Westney.
In other cases, patients may need a urostomy because they have radiation damage to the bladder caused by cancer treatment. When this happens, the bladder needs to be replaced by a urostomy because it’s no longer functional.
How can a patient prepare for a urostomy procedure?
“All these things will help with the recovery and healing phases,” Westney says.
How will the care team help me prepare for my urostomy?
Before you undergo urostomy surgery, a wound ostomy nurse will help in the planning process. They’ll look at your abdominal wall, where your belt sits and areas where your abdomen is flat to determine the best location for your stoma.
After surgery, wound ostomy nurses help you get used to changing your pouch, or catheterization, depending on the situation.
What is the recovery like for a urostomy?
Most patients who need a urostomy are also recovering from the removal of the bladder.
Westney says the initial recovery phase requires getting used to your stoma appliance, which is similar to an ostomy bag.
“Patients will need long-term imaging follow-up of their kidneys to make sure that the urostomy is functioning optimally. Some patients may change the brand of stoma or adhesive to find what works for them.
What are the side effects of a urostomy?
“There is no additional pain related to the stoma itself,” Westney says. “The major recovery is related to the surgical incisions.”
In rare cases, patients may experience skin irritation at the location of the appliance. After a long period, 10 to 20 years, the stoma may require a revisionary procedure.
What kind of care is needed for a stoma?
“Patients with appliances need to become comfortable with changing the appliance and troubleshooting problems with fit and potential leakage,” says Westney. “When those problems arise, talk with your physician and wound ostomy nurse.”
For patients with continent urostomies, it is important to catheterize the pouch regularly as directed. Failure to do so can result in the formation of pouch stones, which may require further surgery for removal.
What else should patients and caregivers know about urostomies and stomas?
“No matter what type of stoma is performed, there is always an adjustment phase,” says Westney.
Most patients feel that it takes 3 to 6 months to adjust and feel comfortable with their stoma. After that point, Westney says, they feel fully confident in resuming a normal activity level.