What is a ureterostomy?

A ureterostomy is a surgery to create a urinary diversion (a change in the path by which urine leaves the body).

In a ureterostomy, the urine bypasses the bladder and exits the body through a stoma—a surgically created opening—and collects into a pouch worn outside the body. After this procedure, you must empty the pouch about as often as you would typically use the bathroom.

How does the urinary system work?

Wastes and fluids leave the body through the urinary tract (the kidneys, ureters, bladder and urethra). Urine comes from the wastes and extra fluid that the kidneys filter out of the blood.

From the kidneys, the urine travels to the ureters—narrow tubes leading from each kidney—down into the bladder. Normally, a body has two kidneys and two ureters. The bladder collects the urine and empties it from the body through another small tube called the urethra.

When is a ureterostomy recommended?

A doctor may recommend a ureterostomy when the body cannot rid itself of urine normally. There are several reasons why your doctor may recommend a ureterostomy, including if you:

• Have a birth defect, such as spina bifida
• Have had your bladder removed (possibly because of cancer)
• Have a bladder that no longer works properly
• Have a spinal cord injury

A ureterostomy permanently reroutes the flow of urine through an opening in the abdominal area to a collecting pouch outside of the body.

If urine cannot leave the body, it can cause urinary tract infections, kidney failure and even death if the problem is not resolved.

What happens before a ureterostomy?

Before a ureterostomy, you may have the following tests:

• Kidney function tests to analyze the blood and urine to see how the kidneys are working
• Blood tests
• Imaging studies, such as an X-ray or an ultrasound (a procedure that uses sound waves to produce pictures of the ureters and kidneys)

A stoma therapy nurse will also consult with you to provide preoperative education, and decide on a location for the stoma that is easily seen—not in a skin fold or interfere with the belt line.

In addition, the doctor may order the following tests:

• Intravenous pyelogram: During this test, dye is injected into a vein to check how long it takes to pass through the kidneys, ureters and bladder after it enters the system.
• Retrograde pyelogram: This procedure involves taking an X-ray of the kidney and ureters. Dye is also injected in this test, but it is in the ureters, not a vein.
• Antegrade nephrostogram: An X-ray is used in this test to look for any blockage in the kidneys and ureters. Dye is injected into the ureter, through a previously placed external tube that goes through the kidney (Nephrostomy tube).
• Computerized tomography (CT) scan: This test is a special imaging technique that uses a computer to collect multiple X-ray images into a two-dimensional cross-sectional image.
• Magnetic resonance imaging (MRI): An MRI is a special technique that provides detailed pictures of internal parts of the body, like the kidney and ureters.

How is a ureterostomy done?

During a ureterostomy, a surgeon disconnects one or both ureters (the thin tubes attached to the kidneys) from the bladder. The ureters are then attached directly to the abdominal wall to a surgically created opening in the skin called a stoma. A stoma can be up to three inches wide, and allows wastes to pass out of the body. The stoma does not have a sphincter, or a muscle, that allows it to open and close, so it is unable to control the flow of urine.

Because the bladder is no longer part of the process, the urine does not have a place to collect before exiting the body. Instead, it exits the body directly into a plastic pouch that is attached to the outside of the body around the stoma.

After a ureterostomy, how does the new system work?

Your new urinary system will work in the following way:

• The pouch is placed outside the stoma (the opening in the abdomen) and collects the urine from the body.
• There are two pieces to the pouching system: a barrier and a collecting pouch. (They sometimes come as one unit.) The square-shaped barrier piece has a hole in the center that fits over the stoma and sticks to the skin. The sticky substance on the barrier is strong enough so that urine does not leak outside of the pouch.
• The pouch attaches to the barrier and collects the urine as it leaves the body.

Most people empty the pouch about as often as they used the bathroom before the ureterostomy. Typically, you empty the pouch when it is about one-third to one-half full. There is a valve at the bottom to allow the urine to be emptied into a toilet without removing the pouch from the stoma.

At night, you can attach a piece of flexible tubing to the valve on the pouch to allow urine to flow into a larger pouch while you are sleeping.

Pouches lie flat against the body and are attached securely to the skin. Clothing fits over the pouch and covers it, so it is not noticeable to others.

What happens after a ureterostomy?

After the ureterostomy, a caregiver will show you how to clean and care for the stoma, the skin around the area, and the pouch. You will also learn how and when to change the pouch.

Do I have to restrict activities after a ureterostomy?

You will need to restrict your activities, especially driving and heavy lifting, for the first four to six weeks after the surgery. The wound must heal before you can continue doing strenuous physical activities. When the stoma has healed, you can usually return to your normal lifestyle, including swimming and other water sports. The doctor may recommend that you not participate in full-contact sports, such as football or karate.

How should I take care of the stoma and pouch?

A nurse will teach you how to care for a stoma and how to change the pouch regularly.

It is important that the stoma remain clean and dry. Every day, you should:

• Wash the stoma and surrounding skin with mild soap and water.
• Rinse the area thoroughly.
• Dry the stoma completely.

The pouch must also be changed on a regular basis. The old pouch should be thrown away and a new pouch placed every five to seven days.

When should I call my doctor?

You should watch the stoma and surrounding skin. If any changes occur, call your doctor. Changes can include:

• Rash or redness
• Skin that breaks down
• Sores that develop on the skin

Skin breakdown may occur where urine leaks between the pouch and stoma.

Because bacteria and germs may easily get into the stoma, it can get infected, which may lead to a urinary tract infection. Symptoms of infection include:

• Dark-colored urine
• Excess mucus in the urine or around the stoma
• Strong-smelling urine
• Back pain
• Fever
• Nausea and/or vomiting
• Poor appetite

If these symptoms occur, you should call the doctor.