urostomies

A urostomy is a surgically created opening on the abdomen that diverts urine away from the bladder to an external collecting ostomy bag. It is a type of urinary diversion used when the bladder cannot store or pass urine normally, such as after bladder removal or severe bladder dysfunction.

The most common form is an ileal conduit, in which a short segment of the small intestine (ileum) is used to connect the ureters to a stoma on the abdomen. Urine drains continuously into an external pouch. Other options include continent urinary reservoirs (continent cutaneous diversions, such as a Kock or Indiana pouch) that use a segment of intestine to create a reservoir connected to a stoma; this type requires periodic self-catheterization to empty the reservoir. Ureterostomies or vesicostomies are other forms, often used in children or specific clinical situations. Orthotopic neobladders, which use a reconstructed bladder placed in the natural location, are alternatives that may not involve a stoma but are not considered urostomies.

Indications for a urostomy include bladder cancer requiring cystectomy, severe bladder dysfunction or incontinence when other treatments have failed, traumatic injury, or congenital abnormalities. The procedure creates a reliable way to store and/or drain urine without using the native bladder.

Stoma care involves a skin-friendly barrier, an external pouch system, and regular changes to prevent irritation and leakage. Patients may notice mucus in the pouch, which is normal. Education from a wound, ostomy, and continence nurse is important for selecting appliances, maintaining skin health, and managing changes.

Common complications include stoma stenosis or retraction, parastomal hernia, skin irritation, blockage of the conduit or reservoir, urinary tract infections, and electrolyte or fluid balance issues in some diversions. Regular follow-up ensures function, kidney health, and adjustment of care as needed.