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Urostomy Complications: What to Expect After Your Surgery

Urinary diversion surgeries are generally safe, but many times complications can arise with the newly created urinary tract system. This article will give you an overview of the most common urostomy complications to expect after surgery. 

What is a urostomy?

A urostomy (urinary ostomy) is a hole in the abdominal wall created during a urinary diversion surgery that acts as the new exit point for urine.

A urostomy is often confused with a stoma. The urostomy refers to the opening on the belly, whereas the stoma refers to the bit of small intestine—the ileum—that is pulled through the hole and sewn onto the outside of the abdominal wall. You can see the stoma as the pink/red, moist, fleshy tissue that surrounds the urostomy. 

Urostomy may also be confused with colostomy or ileostomy, the first refers to the exit point of diverted urine flow, the latter two refer to the exit points of diverted fecal flows.

urostomy, stoma, indiana pouch, kock pouch, continent urine pouch, urinary diversion, urinary diversion surgery
*not drawn to scale  

What does a urinary diversion surgery do? 

Before the surgery, the kidneys will produce urine, which flows down the ureters, into the bladder and out of the body through the urethra. However, when the bladder is diseased or damaged, such as in the case of bladder cancer and spina bifida, urinary diversion surgery is performed to divert the urine flow away from the bladder. 

During the surgery, a pouch is created from a section of the person’s intestines. The ureters are cut off from the bladder and attached to the pouch. A urostomy is made on the abdominal wall, and a channel connects the pouch to the urostomy, thus diverting the flow of urine. 

If you have bladder cancer, the bladder, as well as some organs neighboring the bladder, may be removed. 

The pouch can be made with different sections of the intestine, and it can be continent or incontinent. Continent urinary pouches need to be emptied by intermittent catheters, and incontinent pouches require people to wear a urostomy bag externally to collect urine. 

Common examples of the continent catheterizable pouch are the Indiana pouch and the Kock pouch. The incontinent urinary diversion system is called the ileal conduit. 

What should you expect after the surgery? 

Right after surgery, you will stay in the hospital for four to seven days. There is a risk of developing blood clots post-operation. Moving around helps, and the hospital staff will help you do so.

You also have a risk of developing pneumonia, and you should do exercises to expand your lungs such as coughing and taking deep breaths. 

It is normal to have swelling in your genitals and groin, as well as discharge from the penis or vagina. You may also experience constipation, diarrhea, pain, and soreness. 

When you are first released from the hospital, refrain from strenuous activity for three months. Don’t lift anything heavier than 10 pounds for six to eight weeks since your incision is not healed on the inside. 

You will be able to shower three days after the surgery, at which point you need to take a shower every day to clean your incision, but don’t wash it with soap. Call your doctor if your incision turns redder than before or is draining pus. 

An ostomy nurse will teach you all you need to know about how to manage your new urinary tract system at home. Here is a detailed guide on all the things you should know before and after a urostomy surgery. 

Urostomy complications

If you have a continent urine pouch such as an Indiana pouch, here are some normal things that you can expect: 

  • Leakage of urine: while your pouch is still learning to hold a larger volume, leakage is common. You should also expect to catheterize more frequently while your pouch is learning. 
  • Thick Mucus: mucus may come out of the urostomy, sometimes even blocking the catheter from draining. In this case, you should irrigate your pouch. Your ostomy nurse should’ve given you guidance on how to irrigate.
  • Stoma gradually shrinks in size: your stoma will slowly shrink down in size for weeks or months after the surgery
  • Light bleeding from the stoma tissue: it’s normal for the stoma to give off specks of blood, but it’s not normal if blood is coming from within the urostomy or if bleeding is heavy. 

Here are a list of symptoms that can indicate bigger problems. Contact your healthcare provider if you notice any of these  

  • Blood in urine: if the urine is light pink and the bleeding is very light, it may be due to irritation from the catheter and should resolve when your body becomes more used to catheterization. This is a normal occurrence. However, if the bleeding is heavy, it might indicate damage, trauma or infection
  • Infection: watch out for dark/bloody, cloudy, foul-smelling urine, and fever
  • Blood coming from within the urostomy instead of the stoma tissue, bleeding for 5-10 minutes. 
  • Pain and bulging in the abdomen 
  • Stoma changing more than half an inch in size over a single day
  • Stoma shrinking back into the belly or protruding so much you can see intestines coming out
  • Stoma becoming dry, changes shape or gives off strong odor
  • Stoma turning pale, gray, or purple. This is a sign that blood circulation is cut off from the stoma and you should get immediate help from your surgeon. If that’s not possible, go to the emergency room. 

If you have an ileal conduit, the above problems relating to stoma, blood, and infection applies to you too. Additionally, you may experience allergic reactions to the urostomy pouch system, and other irritations due to an ill-fitting pouch system. Therefore it is important for you to test different products out and decide on what’s best, and to get the pouch system to fit correctly around your stoma. A tight fit can irritate the stoma and a loose fit can cause urine to leak out, irritating the skin around the stoma.

Here is a more detailed guide on how to care for your urostomy and all the warning signs to look out for. 

Life after Urostomy Surgery 

You may experience intense feelings, such as sadness, anger, nervousness, and irritability. It’s important to get the support that you need. You can join local or online support groups, or get counseling service. 

Although you would be living with an altered urinary tract system, after a full recovery you can expect to resume physical activity, including swimming. Remember, the surgery ultimately enables you to live life more fully than you would’ve lived without the surgery. 

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