Urostomies and Continent Diversions

What is a urostomy? Is it like a colostomy? What is a continent diversion? Is it like a J-pouch? Urostomies help drain urine from the body while a colostomy or ileostomy drains stool from the body. Managing a urostomy is similar to managing a colostomy or ileostomy. The pouches have different openings but managing the barrier portion is the same. 

Urostomies and Continent Diversions

Why is a urinary diversion needed? 

Urostomies are created for those who need to have their bladder removed, most often because of cancer but injuries can be the cause as well. Others may need a urostomy because the bladder does not function. There are occasions when babies are born with a non-functioning urinary bladder so a urostomy is created immediately and needed for a lifetime. 

What is a urostomy?

It is a stoma created from a small piece of small intestine used to create a pathway for urine to flow out of the body. The ureters from the kidneys are attached to the small intestine portion that is used to create the stoma. The pouching system to collect urine is much like the ones used for colostomies and ileostomies. The pouch portion of the system is different. It has a tap or valve at the bottom to drain the urine. The pouch also has a feature where the urine cannot reflux back toward the stoma.

What is a urostomy

Are there any dietary changes for those with a urostomy?

In the immediate post-operative period, your diet will be restricted as you heal from the small intestinal harvest for the urostomy. This means, low residue or low fiber, no raw fruits or vegetables, no seeds or nuts, and no bulky meats such as steak or pork chops. Your diet will advance to a regular diet a few weeks after surgery.

No dietary restrictions are needed for urostomates once healed. The only restrictions are those required for other health issues. However, it is important to remain hydrated.

Work and activities are not restricted except for avoiding heavy lifting, pulling, or pushing. These activities will increase your risk of developing a parastomal hernia.

Clothing does not need to be altered. Most times the urostomy is placed below the natural waistline and covered by slacks. If you choose to wear a leg bag as a larger reservoir to hold urine, you may choose to avoid wearing short skirts or short pants. If swimming, remove the leg bag and use just the pouch. Contact sports can be dangerous for the stoma. It is recommended you wear a stoma guard to protect against injury to the stoma.

A night drainage system can be used to store urine while sleeping. Otherwise, you will be up multiple times to empty the pouch.

 

What is a continent diversion?

A continent urinary diversion or pouch is a surgical procedure where a portion of the small intestine is used to create a reservoir to hold urine inside the body (a new bladder.) The ureters are surgically connected to the bladder reservoir. To empty the new bladder, you will need to insert a catheter into an opening at the skin level. With this surgery, no ostomy pouch is needed. You will need to catheterize every 4-6 hours. There are different types of continent pouches.

  • Indiana Pouch 
  • Modified Kock Pouch 
  • Mitranoff Pouch 
  • Miami Pouch 
  • Mainz Pouch 
  • Camy Procedure 
  • Ileal Neobladder

The type of pouch created is recommended by the surgeon. Not all continent diversions are appropriate for everyone. Because the continent pouches are created with the small intestine, mucous is present. It is important to irrigate the continent pouch daily with normal saline to flush out the mucous. If this is not done the risk of infection increases. The catheter used to empty the bladder pouch can be reused but cleaned after each use.

Symptoms of infection include:

  • Fever and/or chills 
  • Abdominal or back pain 
  • Cloudy or foul-smelling urine 
  • Visible blood in the urine 
  • Nausea/vomiting 
  • Diarrhea 
  • Weakness 
  • Increased thirst

Should any of these symptoms occur, call your doctor immediately. It is a good idea to wear a medical alert bracelet in case of an emergency where you are not able to notify medical personnel of your special needs. 

 

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Urostomies and Continent Diversions