Different Types of Urostomy Surgery

Different Types of Urostomy Surgery

 I felt I needed to write this post and clear up some confusion over terminology. I’ve now had Squirt for a year and a half and I’ve only recently become fully aware of the difference between a Urostomy and Ileal conduit.

So after much research and talking to the stoma nurses and Doctor I now have the answer! 

A Urostomy is a surgical procedure that creates an artificial opening called a stoma that re-directs urine away from the bladder. The bladder may be removed completely (cyctectomy) or diverted from due to it being diseased, neurological conditions,, birth defects and accidents. An ileal conduit is a surgical procedure

The different types of urostomies are: - Ileal Conduit

- Continent Urostomy

- Bladder Reconstruction

Ureterostomy

Ileal Conduit

                  Urotomy 2                                               Urostomy 3                                                                                                                                                              
  • Most common form of urinary division used. This is what I have!!

  • This operation is usually needed when the bladder has been removed (cystectomy or bypassed because of disease or injury

  • During surgery a segment of ileum is used for the diversion of urinary flow from the ureters. The segment is resected from the intestines with nerves and blood supply intact with the ureters attached to it. One end is closed while the other is brought to the outside of the abdominal wall to create a stoma. The urine flows through the newly formed ileal conduit and the stoma into an external pouch. The pouch has an outlet for releasing urine into a toilet without removing it from the stoma.

  • The small intestine produces mucus naturally. The segment of intestine that was used to form the ileal conduit or urine pocket will keep making mucus, too. The mucus will collect in the pouch along with the urine. This is normal.

  • For 1-2 weeks after surgery the stoma will have stents coming out in order to ensure that the conduit is drawing and to give the joints time to heal.

Continent Urostomies

Urostomy 5                                                                       Urostomy 4
  • Also called Indiana pouches
  • Avoids the need for a stoma bag and is a more complicated operation than the ileal conduit

  • Involves the creation of a pouch or bladder inside the body, usually using part of the digestive tract and is emptied intermittently with a catheter 4-5 times a day.

  • A surgeon makes an internal pouch which has 3 main parts to a continent urinary diversion

1. The formation of a reservoir to hold the urine.

2. The formation of a channel to allow urine to flow out of the reservoir.

3. The continence mechanism or valve, which keeps the urine in the reservoir until it is convenient to empty it.

  • Usually, the surgeon makes the stoma under your tummy button (navel), so that it does not show under clothes.

Bladder Reconstruction

                                                                 Urostomy 7
  • This operation is not for everybody and is quite complicated

  • In some cases it may be possible to create a “new bladder” called a neobladder

  • A section of your bowel is removed and reconstructed into a balloon like sack before connecting the urethra at one end and the ureters to the other end

  • Due to loss of normal nerve function around 20-30% of people with a neobladder will experience some episodes of incontinence usually at night.

  • Due to the bowel producing mucus this may block the urethra so Intermittent Self-catherisation (ISC) is required as well as regular bladder flushes.

  • So after your operation, urine flows down the ureters as normal, and collects in the pouch forming your new bladder. 

  • When you want to pass urine, you hold your breath and push down into your abdomen. It is a bit like pushing to open your bowels, but you use the muscles closer to the front of your tummy instead of those near your back passage. Doctors call this the Valsalva manoeuvre.

Recto-sigmoid Pouch

                                                                            Urostomy 8
  • Also called a Mainz 11 Procedure. Although this is quite rare
  • The rectum is made into a pouch by adding a piece of bowel taken from higher up and the ureters are attached to the pouch.

  • The pouch collects the urine and it is the anal sphoncter and muscles in the bottom that hold it in.

  • After this operation urine is passed out with the stools 

Ureterostomy

                                                          Urostomy
  • Very rarely performed.

  • One or both of the ureters are redirected from the kidney and brought out directly through the abdominal wall.

  • An opening may be placed on one side or both sides of your body. You will have a pouch for each opening.

So to summarise a Urostomy is a surgical procedure that creates a stoma (artificial opening) for the urinary system and requires a pouch to be worn outside the body, or a continent diversion where a pouch or neo-bladder is formed inside the body. The Ileal Conduit is made from a short segment of the small intestine after removing the bladder.

Written by : Rachel Jury

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