How Will I Manage A Urostomy?

Removal of the entire bladder, radical cystectomy, is the gold standard treatment for invasive bladder cancer. Rarely, individuals may be candidates for less invasive surgery or bladder-sparing regimens. Historically, the primary option to divert the urine after a radical cystectomy was an ileal conduit .

Over the years, a variety of continent urinary diversions and “neobladders”  have been developed in an effort to allow people to feel as “normal” as possible. In some individuals—that is, those who lack manual dexterity, who are dependent on caregivers—an ileal conduit is the most appropriate form of urinary diversion. In others, the surgeon may recommend an ileal conduit, or the patient may choose an ileal conduit.

As with a colostomy, an ileal conduit has a nipple-like opening on the anterior abdominal wall (the belly) through which the urine passes into a specially designed collecting bag. Periodically throughout the day the bag is emptied. In the evening, extension tubing may be connected to the bag to allow the urine to drain con-tinuously into a larger bag to prevent the bag from fill-ing to capacity at night.

Several worries and concerns come to a patient’s mind when an ileal conduit is proposed or discussed: (1) How will the ileal conduit change my body appearance, or will my spouse find me unattractive? (2) Will others be able to detect that I have a bag; that is, will it show through my clothes, and will it smell? (3) Do the bags leak? The surgery to remove your bladder requires an abdominal incision. Typically, this will heal as a pencil thin line that runs up and down the middle of your abdomen.

In select institutions, surgeons are performing the surgery via a laparoscopic approach to allow for a smaller surgical incision and ideally a quicker recovery. Thus, you will already have a small change in your physical appearance related to removing the bladder. The size of the stoma and the location of the stoma will vary with the segment of bowel used to make the urostomy.

Typically, a segment of small intestine, ileum, is used. The ileum is smaller than the colon and often the size of the stoma is smaller than a half-dollar coin. The ileum is mobile, and this allows the surgeon to locate the stoma where it will be easiest for you to access and be most comfortable.

Often, you will meet with a stoma therapist before your surgery, and this individual will select the most appropriate site(s) for your stoma location depending on your body habitus, where the waist of your pants/skirts falls and the segment of bowel that the surgeon plans to use.

Ileal conduit stomas tend to be located lower in your abdomen than those derived from a segment of the large intestine. The large intestine is often used for a urostomy in individuals who have a history of prior pelvic radiation because it is the segment of bowel that is least likely to have been damaged by the radiation treatments.

There are two components of the drainage system: (1) an adhesive wafer with a circle the size of the stoma cut out of it that adheres to the skin around the stoma and (2) the collection bag that snaps onto the wafer with a watertight seal. The wafer also protects the surrounding skin from irritation from the urine. The bag is flat, so it is not discernible in your clothing unless it is very full and your clothing is tight. The collection system is designed to be watertight.

Leakage may occur if you fail to secure the bag to the wafer correctly or if you do not close the drainage port at the bottom of the bag properly. Because it is common to make more urine at night, an extension tube may be connected to the bottom of the urostomy bag and to a larger collection bag to avoid having to awaken at night to empty the bag.

Patient says:

I had a radical cystectomy and an ileal conduit. The stoma therapist saw me before my surgery and marked the best location for the stoma. After the surgery I wanted to resume my golf and tennis activities, but I was so afraid the bag would pop off and I would be soaked in urine.

My wife sews a lot and came up with a great idea. She made a pocket in my boxer shorts. I could put the stoma bag into the pocket, which prevented it from flopping around. It has worked out great. Now I am playing golf, tennis, even swimming.