What Are The Possible Long-term Problems With A Urostomy?

Long-term problems after an ileal conduit are not uncommon. Overall, up to two thirds of patients will experience some type of problem. These problems can be categorized as follows.

Stoma: About one in four patients will have a problem related to their stoma. The most frequent problems are parastomal hernias (a weakening of the tissues around the stoma, allowing the intestines to bulge around it), stomal stenoses (narrowing of the opening of the stoma), and irritation/bleeding. If the appliance does not fit properly, the skin surrounding the stoma may become irritated and prone to yeast infections. The majority of these occur during the first few years after surgery.

Bowel: A similar number of patients (about 25%) will have problems related to their bowels. These problems include bowel obstruction, diarrhea, and fistulae. Infection: Urinary tract infections and/or kidney infections occur in 5% to 10% of patients in the first few years after surgery.

Most of these infections are not serious and can be easily treated with antibiotics, but a few patients will get serious or recurrent infections. Urinary obstruction: About 10% of patients will have a stricture of the connection between the ureter and the conduit. These strictures can block the drainage of urine from the kidneys, causing obstruction. They often require a second surgery or placement of stents to unblock the kidneys.

Stones: Some patients will develop kidney stones several years after the procedure. The rate rises over time, and up to 40% of patients may have a stone at 10 years after the procedure.

Electrolyte disturbances: The bowel has evolved to absorb nutrients and to secrete waste products from the system. Although this is advantageous in the usual setting, it can be problematic when we reassign it to carry urine.

When the bowel is exposed to urine, it may overabsorb salts and acids that the kidneys have secreted. This can usually be corrected with medications. Continent diversions and neobladders have urine exposed to the bowel for longer periods of time and thus are more prone to these types of problems than are ileal conduits.