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  • Urostomy

    (Urinary Diversion Surgery)

    Definition

    A urostomy allows urine to pass out of the body through a stoma (small hole) in the abdomen. A tube is connected from the urinary system to the stoma. Urine passes through the tube into an external pouch. Sometimes, an internal pouch, or neobladder, can be created.
    The Female Urinary System
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    A urostomy tube may be needed if urine can no longer pass from the kidneys through the bladder and out the urethra. If this occurs, urine can back up. This can cause damage to the kidneys. Causes for this include:
    • Bladder cancer
    • Birth defect
    • Chronic inflammation
    • Nerve-muscle control problems

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have a urostomy, your doctor will review a list of possible complications, which may include:
    • Skin irritations
    • Fluid build-up in the abdomen
    • Urine flow blockage
    • Damage to other organs
    • Bleeding
    • Infection
    • Blood clots
    • Adverse reaction to the anesthesia (eg, light-headedness, low blood pressure, wheezing)
    Factors that may increase the risk of complications include:

    What to Expect

    Prior to Procedure

    Your appointments before the surgery may include:
    • Getting a physical exam, including a medical history
    • Talking to your doctor about any allergies you have and medicines you are taking
    • Talking to your doctor about the urostomy tube and practicing with a sample pouch to determine the best place for a stoma
    You may also need to:
      Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Anti-inflammatory drugs (eg, aspirin )
      • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
    • Take laxatives and antibiotics before the procedure.
    • Arrange for a ride home and for help at home.
    • The night before, do not eat anything after midnight.

    Anesthesia

    General anesthesia will be used. It will block any pain. It will keep you asleep through the surgery.

    Description of the Procedure

    An incision will be made in the abdomen. This will expose the bladder area. The doctor will attach a tube to part of the urinary tract. The other end of the tube will be attached to an external pouch or a pouch in the abdomen. The doctor will close the incisions. Depending on the cause of the urinary system problem, other procedures may need to be done.

    Immediately After Procedure

    Your breathing tube will be removed. You will be taken to the recovery room.

    How Long Will It Take?

    About 2-5 hours (depending on your condition)

    How Much Will It Hurt?

    Anesthesia will prevent pain during the surgery. During recovery, your doctor will give you pain medicine.

    Average Hospital Stay

    You will be in the hospital for about 5-12 days. This will depend on your condition and the reason for surgery. Your doctor may keep you in the hospital longer if you have any complications.

    Post-procedure Care

    At the Hospital
    At the hospital, you will:
    • Walk as soon as you are able to help prevent blood clots.
    • Receive fluids intravenously (through a vein in your arm) until you are able to eat and drink.
    • Learn how to change the urine pouch and dispose of urine.
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • To avoid infection, care for your stoma as directed.
    • Change your pouch on a regular schedule.
    • Avoid strenuous activity for 4-6 weeks.
    • Avoid heavy lifting, straining, and sexual activity until you have fully recovered.
    • Do not drive until your doctor says that it is safe to do so.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Be sure to follow your doctor's instructions.

    Call Your Doctor

    After you leave the hospital, call your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Pain in the back
    • Poor appetite
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision and/or stoma site
    • Change in stoma size
    • Nausea and/or vomiting
    • Pain that you cannot control with the medicines you have been given
    • No urine coming out of the urostomy, extreme cloudiness or pus in the urine, a bad odor to the urine
    • Cough, shortness of breath, or chest pain
    If you think you have an emergency, call for medical help right away.

    RESOURCES

    American Cancer Society http://www.cancer.org/

    United Ostomy Association of America http://www.uoaa.org/

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca/

    Canadian Urological Association http://www.cua.org/

    References

    Kellicker P. Discharge instructions for cystectomy. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated October 1, 2009. Accessed February 10, 2010.

    Kohnle D. Cystectomy. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated November 1, 2009. Accessed February 10, 2010.

    United Ostomy Associations of America website. Available at: http://www.uoaa.org/ . Accessed February 10, 2010.

    Urostomy a guide. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI%5F2%5F6x%5FUrostomy.asp . Accessed February 10, 2010.

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