The creation of a stoma for a ureter or kidney.
Performed to divert the flow of urine away from the bladder when the bladder is not functioning or has been removed.
Indications may include: bladder cancer, spinal cord injury, malfunction of the bladder, and birth defects such as spina bifida.
There are two basic types of urostomies.
The first creates a passage called an ileal conduit, where the ureters are detached from the bladder and joined to a short length of the ileum.
In the ileal conduit urostomy one end of the ileum piece is sealed off and the other end is brought to the surface of the abdomen to form the stoma.
The ileal conduit urostomy is the most common technique used for urinary diversion.
The other type of urostomy is a cutaneous ureterostomy where there is detachment of the ureters from the bladder and brings one or both to the surface of the abdomen via a stoma and urine is collected in a bag.
Ureterostomies may be single, that brings only one ureter to the surface of the abdomen, or a bilateral ureterostomy, that brings the two ureters to the surface of the abdomen, one on each side.
A double-barrel ureterostomy, brings both ureters to the same side of the abdominal surface.
A transuretero ureterostomy, brings both ureters to the same side of the abdomen, through the same stoma.
The condition of the ureters following surgery is monitored by IVP testing, repeated postoperatively at six months, one year, and then yearly.
Following ureterostomy, urine needs to be collected in bags.
Urostomy bags are available as one- and two-piece bags: One-piece bags have the adhesive and the bag are welded together, making it easy to apply.
Two-piece bags have the bag and the adhesive as two separate components, and the adhesive does not need to be removed frequently from the skin.
The complication rate associated with ureterostomy procedures is less than 5–10%.
Risks during surgery include the usual complications of cardio- pulmonary problems, and injury to adjacent structures, such as bowel or vascular entities.
Inadequate ureteral length may also be encountered.
Anastomotic leak is the most frequently encountered complication.
The highest rates of complications exist for patients who have pelvic cancer or have had previous radiation therapy.