Characteristics of a Urostomy

–Removal of bladder   –Ureters connected to segment of ileum   –Stoma created at one end, other end of segment is sutured

A small segment of the ileum may be used as a conduit for a a urinary diversion when the bladder is removed.

Reasons for a urostomy include bladder cancer, neurogenic bladder, interstitial cystitis and congenital anomalies. Looking at the diagram, the incontinent urostomy is created when the bladder has been removed and a portion of the ileum is used as a passageway (conduit) for the urine. This is not a storage area. The ureters are tunneled into the ileal segment and the distal segment is brought up to the outside of the abdomen to form a stoma. This is called an ileal conduit and is usually situated on the right lower quadrant of the abdomen. A pouch is worn at all times to collect the urine. It is important to teach the patient that it is normal to see mucous shreds in the urine. Instructions on how to maintain an acidic pH of the urine to decrease the potential for urinary tract infections includes use of vitamin C and cranberry juice, and by pushing fluids.

There are several continent urinary diversion options.

Neobladder

•Created from a portion of the patient’s small intestine •Allows for more normal voiding

A non-orthotopic option is the Indiana or Kock pouch, and uses the ileocecal valve as the continence mechanism. A portion of the ileum is used to create a storage pouch with a capacity between 400-800ml of urine. A discrete, flush stoma is created in the abdominal wall which the patient then regularly intubates or catheterizes to allow for emptying at regular intervals. This type of reservoir sits in the abdomen. Another continent option is the orthotopic neobladder, which does not need a stoma. A reservoir (which becomes the new bladder) is created from either the small or large intestine. This reservoir is sewn to the urethra and the ureters are implanted into the bowel segment. Of all the options, this one provides the patient with the most “normal” voiding process. This option is entirely internal, and the new bladder is placed in the pelvis where the bladder used to reside.[1] The most common post-op problem with the neobladder is nighttime bed wetting. •The new bladder is created using a portion of the small intestine and placed in the former bladder area. •The ureters and urethra are attached to the neo bladder. Patients will not have the same urge to void. •The abdominal muscles are used to drain urine out. Some patients will have some incontinence. •Some patients may have retention issues requiring intermittent catheter use. J-Pouch This is a procedure where a portion of the small intestine is used to make a new rectal collection pouch.. The intestine is formed into a J and attached to the top of the anal canal. This is often used for Ulcerative Colitis patients who have had their entire Large Intestine and their rectum removed Initially they may have up to 15 bowel movements/day and over the next few months decrease to 4-6/day. Initially they may have some trouble with incontinence with also improves. They may be prone to pouch it is which is inflammation in their pouch which will need to be treated.   1.Cancer – Renal, Pelvis or Ureter. Medline Plus. August 19, 2010. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000525.htm. Accessed October 8, 2010.