What is an Urostomy

Urostomy is a surgical procedure that is done to create an opening (stoma) for urine to leave the body. This procedure may be done if a medical condition prevents the usual flow of urine into your bladder and out of your body. It may also be done if you have had your bladder removed.

During the surgery, the tubes that drain urine from your kidneys (ureters) are connected to a piece of intestine. This piece of intestine is attached to the stoma made in the front of your abdomen. A bag or pouch is fitted over the stoma to catch your urine.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Blood clot.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Do not use tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Plan to have someone take you home after the procedure.
• You may have an exam or testing.
• You may be prescribed an oral bowel prep. This involves drinking a large amount of medicated liquid, starting the day before your surgery. The liquid will cause you to have multiple loose stools until your stool is almost clear or light green. This cleans out your colon in preparation for the surgery.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• A tube (nasogastric tube) may be put through your nose into your stomach. This will remove stomach fluids and help prevent nausea and vomiting.
• An incision will be made in your abdomen.
• A small piece of intestine will be removed, and the remaining ends of intestine will be stitched (sutured) back together. The ureters will be attached to the small piece of intestine (ileal conduit).
• The ileal conduit will be brought up and attached to the abdominal wall, creating the stoma that urine can pass through.
• Small tubes (stents) may be placed in the ureters to make sure the flow of urine is not blocked if the ureters swell after surgery.
• The muscles of the abdomen will be sutured back together, and then the skin will be sutured or stapled. A bandage (dressing) may be used to cover the incision or incisions. A urostomy pouch will be attached to the stoma.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You will be given pain medicine as needed.
• You may continue to have the nasogastric tube in place until your intestines are working normally again.
• You will be encouraged to breathe deeply and to cough. This helps your lungs recover from surgery.
• At first, you may only be allowed to suck on ice chips. You will slowly advance to drinking clear fluids and then return to a normal diet.
• You will be taught how to care for the stoma and urostomy pouch.

Urostomy, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Swelling at the opening that was created during the procedure (stoma).
• Slight bleeding around the stoma.
• Redness around the stoma.

Follow these instructions at home:

Activity

• Rest as needed while the stoma area heals.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Avoid strenuous activity and abdominal exercises for 3 weeks or as told by your health care provider.
• Do not lift anything that is heavier than 10 lb (4.5 kg).

Stoma Care

• Follow instructions from your health care provider about how to take care of your stoma area. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to be in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Keep the stoma area clean.
• Clean and dry the skin around the stoma each time you change the urostomy pouch. To clean the stoma area:
  • Use warm water and only use cleansers recommended by your health care provider.
  • Rinse the stoma area with plain water.
  • Dry it well.
• If your health care provider gives you a powder or gel to apply to your skin, apply it as directed. Do not use any other powders, gels, wipes, or creams on your skin.
• Check the stoma area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Measure the stoma opening regularly and record the size. Watch for changes. Share this information with your health care provider.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may be able to shower with or without the urostomy pouch in place. If you bathe with the pouch on, dry the pouch afterward.
• Avoid using harsh or oily soaps when bathing.

Urostomy Pouch Care

• Follow instructions from your health care provider about how to empty or change the urostomy pouch.
• Keep urostomy supplies with you at all times.
• Store all supplies in a cool, dry place.
• Empty the urostomy pouch when it is one-third to one-half full.
• Replace the pouch every 3–4 days for the first 6 weeks, then every 5–7 days.

General instructions

• Follow instructions from your health care provider about eating or drinking restrictions.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Avoid wearing tight clothes directly over your stoma.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have more redness, swelling, or pain at the site of your stoma.
• You have more fluid or blood coming from your stoma.
• Your stoma feels warm to the touch.
• You have pus or a bad smell coming from your stoma.
• You notice a change in the size or color of the stoma.

Get help right away if:

• You have cloudy, bad smelling urine.
• You have bloody urine.
• You have abdominal pain, nausea, vomiting, or bloating.
• You have back pain.

Urostomy Home Guide

A urostomy is a surgical procedure to make an opening (stoma) for urine to leave your body. This surgery may be done if a medical condition prevents the usual flow of urine into your bladder and out of your body.

During the surgery, the tubes that drain urine from your kidneys (ureters) are connected to a piece of intestine. This piece of intestine is attached to the stoma made in the front of your abdomen. A bag (pouch) is fitted over the stoma to catch your urine.

After you have this surgery, you will need to empty and change your urostomy pouch as needed. You will also need to take steps to care for the stoma.

How do I care for my stoma?

Your stoma should look pink and moist. At first, the stoma may be swollen, but this swelling will go away within 6 weeks. To care for the stoma:

• Keep the skin around the stoma clean and dry.
• Use a clean, soft washcloth to gently wash the stoma and the skin around it.
• Use powder, ointment, lotion, or soap on the skin around the stoma only as told by your health care provider.
• Change your urostomy pouch if your skin becomes irritated. The irritation may indicate that the pouch is leaking.
• Measure the stoma opening regularly and record the size. Watch for changes. Share this information with your health care provider.
• Check your stoma area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth
  • Pus or a bad smell.

How do I care for my urostomy pouch?

The pouch that fits over the stoma can have either one or two pieces.

• One-piece pouch. The skin barrier and the pouch are combined in one unit.
• Two-piece pouch. The skin barrier and the pouch are separate pieces. The pouch snaps onto the skin barrier.

Empty the pouch when it is one-third to one-half full. Do not let more urine build up. This could cause the pouch to leak.

Change the pouch every 3–4 days for the first 6 weeks, then every 5–7 days. Change the pouch right away if your skin near the stoma looks irritated.

How do I empty my urostomy pouch?

Before you leave the hospital, you will be taught how to empty your pouch. Follow these basic steps:

1. Wash your hands with soap and water.
2. Open the valve on the tail end of the pouch.
3. Allow the pouch to drain into the toilet.
4. Close the valve and dry it with toilet paper.
5. Wash your hands again.

How do I care for my night drainage system?

You may need to connect your pouch to a larger drainage system at night so that the pouch does not become too full while you sleep. If you use a night drainage system, you will need to take steps to keep it clean.

• Empty the drainage system in the morning. Then wash it with warm soapy water and rinse it carefully. Hang it up to dry for the day.
• Clean the drainage system once a week using a mixture of water and vinegar.
• Keep a cap on the end of the tube when you are not using it.
• If the system cracks or starts to leak, replace it with a new system.

How do I change my urostomy pouch?

Before you leave the hospital, you will be taught how to change the pouch. Follow these basic steps:

1. Wash your hands with soap and water.
2. Carefully remove the old pouch.
3. Wash the stoma and allow it to dry. Men may be told to carefully shave any hair around the stoma.
4. Use the stoma measuring guide that comes with your pouch set to decide what size hole you will need to cut in the skin barrier piece. Choose the smallest size that will hold the stoma but will not touch it.
5. Use the guide to trace the circle on the back of the skin barrier piece. Cut out the hole.
6. Hold the skin barrier piece over the stoma to make sure the hole is the correct size.
7. Remove the adhesive paper backing from the skin barrier piece.
8. Clean and dry the skin around the stoma again.
9. Carefully fit the skin barrier piece over your stoma.
10. If you are using a two-piece pouch, snap the pouch onto the skin barrier piece.
11. Close the tail of the pouch.
12. Put your hand over the top of the skin barrier piece to help warm it for about 5 minutes. This helps it conform to your body better.
13. Wash your hands again.

What are some general tips?

• Avoid wearing clothes that are tight directly over your stoma.
• Always keep the pouch on if you are taking a bath or swimming.
• You can shower with or without the pouch in place.
• Store all supplies in a cool, dry place. Do not leave supplies in extreme heat because parts can melt.
• Whenever you leave home, take an extra skin barrier and pouch with you.
• If your pouch gets wet, you can dry it with a hair dryer on the cool setting.
• It is normal to notice some mucus in your urine.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

Contact a health care provider if:

• You have more redness, swelling, or pain around your stoma.
• You have more fluid or blood coming from your stoma.
• Your stoma feels warm to the touch.
• You have pus or a bad smell coming from your stoma.
• You notice a change in the size or color of the stoma.

Get help right away if:

• You have cloudy, bad-smelling urine.
• You have bloody urine.
• You have abdominal pain, nausea, vomiting, or bloating.
• You have back pain.