Urostomy: Information & Urostomy Specialists

A urostomy is a surgically created artificial bladder outlet on the skin’s surface. The purpose of a urostomy is to divert urine to the outside when the body’s own urinary tract system is unable to do so.

The surgical procedure to create a urostomy is called a urostomy. The artificial bladder outlet can be either temporary or permanent.

The term “urostomy” is derived from

• the Latin word “uro” (meaning urine) and
• the Greek word “stoma” (meaning slit, mouth, or opening)

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In addition to the urostomy, there is also

• the ileostomy (artificial diversion of the small intestine) and
• the colostomy (artificial opening of the large intestine).

These two types of stoma are created slightly more frequently than a urostomy.

A urostomy is necessary when the urinary tract can no longer expel urine on its own. This may be due to

• damage,
• the closure, or
• removal of the urinary tract.

Even after surgical removal of the bladder, the creation of an artificial urinary outlet is unavoidable.

Possible causes of damage to the urinary tract or removal of the bladder include, among others,

• benign or malignant tumors in the bladder or urinary tract that obstruct or prevent the flow of urine,
• a narrowing of the urinary tract,
• injuries resulting from accidents, as well as
• congenital or disease-related malformations or nerve damage.

In principle, there are four different surgical methods available for creating an artificial bladder outlet:

1. Urostomy via ureterocutaneous diversion

Ureterocutaneous anastomosis is also known as a ureterocutaneous ostomy. Depending on the condition, either

• both ureters are individually routed through the abdominal wall to the outside, or
• the two ureters are first connected to each other and then brought out through the abdominal wall.

In most cases, surgeons first join the two ureters to form a single urostomy and then divert them outward. To do this, they connect the shorter ureter to the longer ureter, provided they are long enough to do so.

The urostomy must not become narrowed, for example due to scar tissue formation. To prevent this, surgeons insert a thin catheter into the ureter to keep it open. This catheter must be replaced by a urologist at regular intervals (approximately every 6 to 8 weeks).

A urostomy can be performed using a minimally invasive ureterocutaneous diversion. This is a suitable option for patients who cannot undergo major surgery.

2. Artificial Bladder Outlet Using a Conduit

In a conduit procedure, both ureters are routed into a short section of intestine, approximately 12 to 15 cm long. This section of intestine is first resected and rendered non-functional. The resected section of intestine serves as the new connection for the ureters. The surgeon directs it outward as a urostomy and positions it in the abdominal wall.

Depending on which section of the intestine is used for the artificial bladder outlet, a distinction is made between

• ileal conduit (when a section of the ileum is used) and
• a colon conduit (when a section of the colon is used).

After the procedure, so-called ureteral stents are used for the initial period following surgery. They ensure that the internal sutures can heal and that urine is excreted evenly.

3. Urostomy via a wet colostomy

In some patients, both the bladder and the rectum are so severely damaged that they must be removed. As a result, they are completely lost as excretory organs. For these patients, a urostomy via wet colostomy is recommended.

In a wet colostomy, the two ureters are first connected to the colon. This causes urine and stool to mix. The colon is then brought out through the abdominal wall to the skin via the urostomy, with a double-lumen tube.

A bag collects the waste here. It must be emptied from time to time.

4. Urostomy via a continent colostomy

In a continent colostomy, an internal urine reservoir (known as a pouch) is created from sections of the intestine. It functions as a replacement bladder.

This replacement bladder is regularly emptied through a closable urostomy via an opening in the abdominal wall. A catheter is used for this purpose. Emptying should take place every 3 to 4 hours, including at night.

Depending on the surgical technique and the sections of intestine used, the procedure is referred to as

• Kock pouch,
• Mainz pouch, or
• Indiana pouch.