Urostomy - Procedure, Indications, and Complications.

What Is the Meaning of Urostomy?

The urinary system comprises organs that are designed to perform their specific functions. The urinary bladder, urethra, kidneys, and ureters are crucial organs of the urinary system. The kidneys filter the blood, form urine, and maintain the fluid and electrolyte levels of the body. Normally, the urine remains stored in the bladder and exits the body through the urethra. However, the problem arises when the bladder fails to function or has been removed surgically. In such a situation, it becomes difficult for the urine to pass through the body in the usual manner. Urostomy is the solution to this problem. It aims to create a new path for the urine to flow outside the body. A hole known as a stoma is made in the stomach to help the patient pass urine without a bladder. As the opening is made in the abdominal region, the patient's urine flow will not be controlled. The urine gets collected outside the body, known as the ostomy pouch.

Why Does the Patient Need to Undergo a Urostomy?

There are a variety of medical conditions that affect the efficiency of the urinary bladder. Sometimes, the person cannot pass urine, and a urostomy is done to facilitate the passage of urine. Urostomy is done under the following conditions:

1. Bladder Cancer - Cancer occurs when the cells present in the human body proliferate rapidly. When cancer originates from the urinary bladder, it is known as bladder cancer. The bladder is removed surgically (cystectomy) to save the other organs from getting damaged. In such a situation, a urostomy provides a new path for the urine to flow.

2. Spina Bifida - It is a congenital condition in which the spinal cord and the spine do not form completely. The patients suffering from this condition usually have a neurogenic bladder. The nerves that control the bladder failed to undergo proper development. The patient finds difficulty in storing the urine or emptying the bladder. As a result, urostomy is the only option left to divert the urine flow.

3. Bladder Exstrophy - It is a congenital condition in which the bladder develops outside the fetus. As the bladder is present outside the body, it might not be able to store urine or function normally. As a result, the urine leaks out of the body, resulting in a condition known as urinary incontinence.

4. Prostate Cancer - The prostate gland is located close to the neck of the urinary bladder. In the case of prostate cancer, the bladder is removed along with the prostate gland to prevent cancer from spreading. Urostomy is recommended in patients suffering from prostate cancer to divert the urine flow.

How Does the Patient Prepare for the Procedure?

The doctor might recommend certain tests and check-ups before the procedure. The following things are important before the procedure:

• The procedure is performed under general anesthesia and takes time, so the patient will be unable to return to work the same day.

• Before the commencement of surgery, general anesthesia will be administered to the patient so that he falls asleep and the surgery is carried out smoothly without any pain or inconvenience.

• The doctor might recommend certain tests and check-ups before the procedure. In addition, the following tests are mainly done before the procedure:

  1. Blood Test - It is important to undergo a blood test before the procedure because it gives a general idea about the health of the patient. It also helps to check the disease or infection present in the body that might interfere with the surgical procedure.

  2. Spirometry - This test helps to check whether the lungs are working properly. It also helps measure the amount the person can hold in the lungs and the amount of air exhaled.

  3. Electrocardiogram (ECG) - This test aims to check heart health. If the heart works fine and supplies blood to the body organs, there will be no complications during the surgery.

  4. Chest X-Ray - It is an imaging test done to diagnose respiratory diseases. The X-ray machine is positioned near the chest to obtain the X-rays. The surgery needs to be delayed if the patient suffers from respiratory disease.

What Happens During the Procedure?

There are different types of urostomies, depending on the method by which the diversion is created. The different types of urostomies and the surgical procedure have been explained below:

The Day of Surgery - The following happens on the day of surgery:

1. First, the patient is given anesthesia so that the surgery remains painless.
2. After the anesthesia has been administered, the patient goes to sleep and is unaware of his surroundings.
3. The doctor examines the abdomen of the patient and marks the site where the opening is to be made (stoma). The chosen spot should be such that the patient can easily reach it.

Different Types of Urostomies - After the doctor has selected the spot for making an incision, he performs either of the following types of urostomies:

• Ileal Conduit: During this procedure, the doctor uses a part of the small intestine to make a tube that connects to the stoma. The ureters will be attached to this newly created tube. So, the urine flows through the kidneys and ureters and exits the body through the new tube.

• Colonic Conduit: In this procedure, the doctor uses a part of the sigmoid colon to create a tube to allow urine drainage.

• Continent Urostomy: A continent urostomy is a procedure in which the doctor uses the intestinal tissues to create a new bladder or a reservoir inside the body. The different types of continent urostomies are listed below:

  1. Indiana Pouch: In this procedure, a part of the small and large intestines is used to make a pouch. The Ileocecal valve, present at the junction of the small and large intestines, is used to make the valve.
  2. Kock Pouch: A part of the small intestine is used to make the valve, outlet, and pouch.

What Happens After the Surgery?

The procedure gets completed in five to six hours, and the patient is taken to the recovery room. It is a surgical procedure, and one cannot expect a rapid recovery. The following things happen after the procedure:

1. The vitals of the patient are monitored until the effect of anesthesia wears off.

2. A drain will be left in place for a few days to remove the abdominal fluid.

3. Also, the patient will be unable to have a solid diet for a few days, so the food will be administered intravenously.

4. The nurse will teach the patient about the technique of wearing the ostomy bag.

5. Do not lift any heavy objects or perform strenuous exercises after leaving the hospital.

How Should the Patient Take Care of Himself After Reaching Home?

It is important to take care of the wound after the surgery. The following steps help to promote healing:

• Wash the operated site with water and antibacterial soap, and pat it dry.

• Take showers only when the operated area has healed completely.

• Visit the doctor for follow-ups and get the dressings changed at regular intervals.

• When the pouch attached to collect the urine is full, empty it to prevent bacterial infection.

• Consult the doctor immediately if the urostomy pouch causes skin irritation or rashes.

What Are the Complications of Urostomy?

Urostomy is a simple procedure, and the patient rarely presents with any complications. The complications of urostomy are listed below:

1. Bleeding from the operated site.

2. Swelling in the legs.

3. Urinary tract infections.

4. If urine's pH (potential of hydrogen) is alkaline, crystals form near the stoma.

5. The patient might be unable to sleep at night due to the constant irritation from the pouch.

Conclusion

Urostomy is a surgical procedure that aims to create a new path for the urine to flow without a bladder. A part of the intestine is connected to the urinary bladder, and the urine flows through it. Urostomy is a boon for those who have a diseased bladder, but some people face difficulties due to the pouch attached to the skin. It is a surgical procedure, so the patient must refrain from some activities that put pressure on the operated site for a few weeks. Once the healing is complete, the patient can return to his job and live a normal life. Sometimes, the patients might feel difficulty handling the ostomy pouch attached to the stoma, but they become used to it as time passes. The urine should be drained once the pouch is one-third to one-half full. If the patient follows all the instructions given by the doctor and visits him regularly for follow-ups, he will not have any difficulty after the surgery.