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Summary

Ureterostomy is a surgical procedure to create an opening in the abdominal wall and attach the ureters (tubes that carry urine from the kidneys to the bladder) to it with sutures. The procedure is done to divert the path of the urine in individuals who have had their bladder removed or have congenital disabilities affecting the bladder.

After the procedure, the urine will flow out from the abdominal opening. You will have to wear a pouch that will collect your urine. Some diagnostic tests need to be done before the surgery

You can resume your normal activities in about two to three weeks after the surgery. You do not need any special clothes or diet after the procedure. A follow-up visit is generally scheduled two weeks after the surgery, but if you notice symptoms such as back pain, fever, or dark-coloured urine, see the doctor immediately.

  1. What is ureterostomy?
  2. Why is ureterostomy recommended?
  3. Who can and cannot get ureterostomy?
  4. What preparations are needed before ureterostomy?
  5. How is ureterostomy done?
  6. How to care for yourself after ureterostomy?
  7. What are the possible complications/risks of ureterostomy?
  8. When to follow up with your doctor after a ureterostomy?

A ureterostomy is a type of urinary diversion surgery in which an opening (stoma) is made in the abdomen and the ureters are connected to the stoma. The urine will now flow from the stoma into a collecting pouch attached outside the abdomen. You will need to wear this bag constantly as there is no muscle to control the flow of urine near the stoma.

The kidneys produce urine, and the ureters are tubes that transport the urine from the kidneys to the bladder. Usually, the bladder holds the urine until you feel like urinating. If your bladder is injured or diseased, you will not be able to urinate, which causes the urine to collect in the ureters and kidneys. In such a situation, you will need a surgical procedure for urine diversion.

A ureterostomy is performed when the body cannot eliminate urine normally. This can lead to problems such as kidney failure, urinary tract infections, and even death if it is left untreated. The doctor may recommend a ureterostomy if you have:

Some common urinary symptoms of spinal cord injury for which ureterostomy can be recommended are:

  • Urinary tract infections
  • Inability to empty the bladder
  • Urinary incontinence (loss of bladder control)

Symptoms of spina bifida that may warrant ureterostomy include:

Ureterostomy is contraindicated in people with the following conditions:

  • Short ureters
  • Ureters that have poor blood flow

Before a ureterostomy, the following preparations are done:

  • Your doctor may order the following tests:

    • Kidney function tests
    • Blood tests
    • Intravenous pyelogram: In this procedure, the doctor injects a dye in the body to assess the functioning of the urinary.
    • Antegrade nephrostogram: During this test, the doctor injects the dye into the ureter by placing a nephrostomy tube into the kidney. X-rays are then taken to check any blockage in the kidneys and ureters.
    • Imaging tests such as magnetic resonance imaging (MRI) or ultrasound.
  • You will need to sign a consent form after discussing the procedure with the doctor. The form will allow the doctor to perform the surgery.
  • Inform your doctor if you are pregnant or have any allergies.
  • The doctor should be informed about all the medicines that you take, including prescription and non-prescription medicines and herbs.
  • Your doctor may ask you to discontinue blood-thinning medicines like aspirin, warfarin, and ibuprofen a few days before surgery. 
  • Do not smoke before the surgery as it may increase the risk of complications. 
  • Do not drink or eat anything after midnight the night before the surgery.
  • Take your medicines on the day of the surgery with a small amount of water.

Once you are admitted in the hospital, you will be given a hospital gown to change into and will be asked to wear antithrombotic stockings (that help in blood circulation). An intravenous (IV) line will be placed in your arm or hand. Antibiotics will be administered to you before the surgery.

The surgery will be performed in the operating room and under general anaesthesia (you will be given a sleep-inducing medicine). It involves the following steps:

  • The surgeon will make an opening in your abdomen.
  • They will detach your ureters from your bladder.
  • The ureters will then be attached directly to the stoma.
  • Finally, the surgeon will use sutures to fix your ureters to the stoma and place a stoma bag over the opening.
  • The surgery may last for about three hours.

You can expect the following after surgery:

  • You will be transferred to the recovery room where a nurse will check your blood pressure and temperature regularly. 
  • Your healthcare provider will administer pain medication to alleviate the pain.
  • Your fluid balance and creatine levels will be checked every day while you are in the hospital.
  • About five to six days later, you will be taught how to handle the ureterostomy bag.

Your IV line will be removed at the time of discharge, that is in about seven days.

You may need to take the following care at home:

Care for the stoma: Take care of the stoma daily in the following manner:

  • Wipe off any mucus on the stoma. Mucus is a sticky substance present in many tissues in our body. Some amount of mucus may come from the stoma. 
  • Use a mild soap to wash the stoma and the nearby skin
  • Rinse and dry the stoma thoroughly

Care for the ureterostomy pouch

  • Clean the skin around the stoma with a washcloth or wet towel, and let it dry completely before you change the pouch. 
  • If you notice any skin irritation, use specially designed protective powder or skin wipes to relieve the irritation. 

Activities

  • In the initial two to three weeks after surgery, try to limit your activities.
  • Do not perform tasks such as driving or lifting heavy weights to facilitate wound healing. 
  • After you have healed, you can resume your regular activities. However, avoid activities such as contact sports and martial arts.
  • Seek advice from your doctor before resuming work if your job requires manual labour. 

Diet

  • You can have a regular diet, but certain foods like seafood and asparagus may cause your urine to have a strong odour. In that case, take advice from your doctor.
  • Drink eight glasses of water daily to flush out all the bacteria to prevent any infection

Clothes

  • Newer models of ureterostomy pouches are designed to not form a bulge under your clothes. Thus, you will not need any special clothes to accommodate the pouch.
  • The pouch can be placed inside your undergarments or between your undergarments and outerwear. 

Relationships and sexual life

  • You may choose to tell people as much as you are comfortable sharing, and they will not know you are wearing a pouch unless you mention it.
  • You can have a normal sexual relationship after the surgery once the doctor gives their approval.
  • Your healthcare provider will explain how to protect the stoma during sex.

When to see the doctor?

Call your doctor if you notice any of the following:

  • Changes on the stoma and surrounding skin, such as release of a lot of mucus, redness, rashes, and sores
  • Changes in urine: dark-colour, strong-odour or presence of mucus
  • Reduced appetite 
  • Fever
  • Back pain
  • Nausea and vomiting

Some of the possible complications include:

  • Wound infection
  • Gastrointestinal bleeding from an unhealed part of the digestive tract
  • Infection of the kidney (pyelonephritis)

Your follow-up will be scheduled in a week after you are discharged from the hospital. During this appointment, the doctor will perform an ultrasound of the upper urinary tract to check for any damage being caused to the kidney due to obstruction in the tract.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Kidney and Urology Foundation of America [Internet]. New Jersey. US; Urostomy and Continent Urinary Diversion
  2. Cleveland Clinic. [Internet]. Cleveland. Ohio. US; Ureterostomy
  3. National Health Service [internet]. UK; Symptoms: spina bifida
  4. National Association for Continence [Internet]. South Carolina. US; Spinal cord injury
  5. Hernandez A, Sherwood ER. Anesthesiology principles, pain management, and conscious sedation. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 14.
  6. Cohen NH. Perioperative management. In: Miller RD, ed. Miller's Anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 3.
  7. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Preparing for Surgery: The Operating Room
  8. Agrawal S, Sarpal R, Dang S, Kalra Y, Biswas M. Indications and outcome of patients undergoing cutaneous ureterostomy as a mode of urinary diversion after radical cystectomy: an experience from a tertiary care center. Int Surg J. 2018 Sep;5(9):3038–3042.
  9. National Institute of Diabetes and Digestive and Kidney Diseases [internet]: US Department of Health and Human Services; Urinary Diversion
  10. Longo N, Imbimbo C, Fusco F, Ficarra V, Mangiapia F, Di Lorenzo G, et al. Complications and quality of life in elderly patients with several comorbidities undergoing cutaneous ureterostomy with single stoma or ileal conduit after radical cystectomy. BJU Int. 2016 Oct;118(4):521–526. PMID: 26935245.
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