Urostomy – Stoma for the Urine

A urostomy is an opening (stoma) in the abdominal wall through which the urine can pass out of the body. The aim is to divert the urinary tract to bypass the bladder.

The four main reasons for diverting the urinary tract are:

• A cancerous growth in the bladder (the most common).

• Neurological problems affecting the functioning of the bladder.

• Chronic infections in the bladder

• Congenital defects.
 

There are various surgical options for diverting the urinary tract. The most common operation is called an “Ileal Conduit.” In this surgery, the bladder is cut and the ureters are attached to a short section of the small intestine which has been detached earlier from the digestive system. This section services as the conduit for the urine. The surgeon leaves stents in the area linking the ureter and the new conduit. Their purpose is to help in creating the connection and to prevent stenosis or blockage during recovery. The stents stay in for 7-14 days after the surgery. During the surgery, the surgeon takes 1-2 cm from the end of the intestine to the abdominal wall (usually on the right side). This is the stoma, which is permanent.

Kidney functioning is not affected by the surgery, but the way in which your bladder is emptied will change. The urine comes out through the stoma in the abdominal wall into a drainage bag. This bag remains permanently on the abdominal wall but is regularly changed.

You will not have ability to control the passage of urine or any sensation of it coming out of your body. No closing muscles allow for any restraint.

The average recovery time for this kind of surgery is 6-8 weeks.

The stoma will work immediately after the surgery. The department nurses will initially monitor its appearance and activity over the first few days. Once you begin feeling better, they will teach you how to deal with the stoma on your own.  At the beginning, this might seem complicated and take a long time, but the more you practice, the easier and quicker it will become.

Feelings of sadness, depression and even mourning are common after surgery, particularly in light of the physical change and new way of life. We recommend you freely express these feelings and share your emotions with those around you.

How a normal stoma looks:

• The stoma is round or elliptical.

• Color: red or pink (like the color of saliva)

• The stoma is moist

• Contains small blood vessels that may bleed a little during cleaning.

• Lack of feeling: insensitive to pain (beware of applying too much pressure).

• The stoma secretes mucus (natural substance coming out of the intestine).

• Urine is diluted and clear and contains strands of mucus.

 

Treating the stoma

Equipment needed for treating the stoma:

• Skin guard sticker. Serves as a base for the bag.

• Drainage bag for absorbing the urine. The bag contains a no-return mechanism which prevents the urine flowing back into the body. There is a faucet at the edge of the bag that allows you to empty it.

• Glue remover – spray/wipes.

• Paper or soft towel, lukewarm water and fat-free soap to clean the stoma and the surrounding skin.

• Paste, sealing rings or glue-enforcing spray for enhancing the seal and preventing urine leakage.

• Protective wipes and powder to protect the skin.

• Accessories: ruler, a balloon catheter, rounded scissors, marker pen.

• A bag for waste.

• Bag for gathering the urine + an adapter connecting to the faucet in the stoma bag (for night use).

• Belt. Gives you a sense of security by holding the skin guard and the bag close to the body.

 

Emptying the bag

The bag can be emptied at any time. When it is up to a third full, you should empty it to prevent it opening or to prevent the skin guard becoming detached from the skin.

To empty the bag, sit or stand with your legs apart over the toilet bowl and empty the contents into the bowl using the faucet at the end of the bag. Wipe the faucet after the bag is fully emptied.

 

Replacing the skin protector

We recommend that you do this in privacy. The change can be made either sitting or standing, as long as you can see the stoma. You can do it opposite a mirror as well.

 

Frequency of replacement

If your equipment comes in two separate parts – the skin protector (base) and bag: replace it twice a week.

Equipment in one part: once every three days.

 

Factors affecting skin guard replacement frequency 

• Urine leakage: irritation and a burning feeling around the stoma. In this case you must remove the skin guard, clean it, dry it out and stick it on anew.

• In the summer, after physical effort or workouts, the heat and the moisture cause excess sweating and you will have to replace the skin guard more frequently.

• Oily or scarred skin next to the stoma.

• Extreme weight loss or gain that causes a change in abdomen structure and hence requires the adjustment of all the stoma equipment.

 

Time of replacement

In the morning, before you drink (ie when there is a small amount of urine.)

Prepare everything you need in advance.

 

How to replace the skin guard

1. Carefully remove the skin guard and the bag, while holding the skin in the opposite direction (or use glue remover). Clean the residue on the stoma with a wipe.

2. Determine the diameter of the stoma using a ruler or a suitable pre-arranged template.

3. Mark the diameter on the outer side of the skin guard and cut the opening of the guard to match the stoma diameter, or check that the opening cut in advance is suitable for the stoma (when the stoma diameter is stable, you can cut the skin guard in advance). Leave 1-2mm between the stoma and the skin guard.

4. Remove the paper from the skin guard.

5. Create a layer of protection using the paste or the sealing rings around the cut opening. Best to let the paste dry before sticking on the skin (10-30 mins)

6. Clean the skin around the stoma with lukewarm water and fat-free soap using a paper or soft towel, and let it dry well. Do not rub the stoma because it could bleed.

7. Place a paper towel on the opening of the stoma to absorb the urine and keep the skin dry.

8. Use a wipe to protect the skin around the stoma. Let it dry.

9. Place the skin guard so that the stoma is opposite the center of the inner opening and stick it to the skin. Make sure the skin is dry, clean and taut.

10. Attach the bag ring to the skin guard ring. Check there is complete closure and sealing between the bag and the skin guard, and that the bag faucet is closed.

 

After changing the skin guard and bag, lay your hand on the stoma for 15-60 minutes. The warmth of your palm will help the skin guard’s adhesive materials to stick to the body better. Do not wet the skin guard for a few hours after the replacement.

 

Throw the old equipment into the trash can. Not the toilet bowl.

 

Maintaining healthy skin around the stoma

The texture of the skin around the stoma needs to be uniform, without discoloration or damage.

• Keep the area clean.

• At every replacement, assess the structure of the stoma and the appearance of the surrounding skin.

• The skin guard will only stick to clean and dry skin. Do not spread any oily cream underneath it.

• Make sure that the diameter of the skin guard is precisely adapted to the size of the stoma. Likewise, make sure you stick the skin guard down in a full and uniform manner.

• If you sense irritation, or notice redness, rashes, peeling skin or crystals, contact your local stoma coordinator nurse or the hospital. 

 

Guidelines for matching the right equipment

This should be dome with the stoma treatment coordinator or a department nurse. After surgery, the stoma is swollen. It gradually becomes smaller and reaches its permanent diameter after 6-8 weeks, which is why you need to measure its diameter with a ruler once a week. In keeping with changes in diameter size, you change the diameter of the skin guard.

We recommend keeping the all the equipment organized in one cool, dry place.

Do not accumulate too much equipment (it can become damaged).

The equipment is fully funded by the kupot holim. If you buy it yourself it is very expensive. 

During the hospitalization, you will be given a list of the equipment you will need. Take this list to your family doctor or the stoma nurse in your kupat holim to receive the prescription. Go the pharmacy to order what you need. You should order the equipment while you’re still in hospital (have someone help you), so it will be ready for you when you get home.

Upon discharge you will receive a basic kit from us (skin guards and drainage bags).

Always take a replacement kit with you wherever you go.

Please note: There are a wide range of accessories distributed by the various companies. You can obtain most of them through your kupat holim. Your local stoma nurse or the nurse in the department at Shaare Zedek will help you choose the best equipment for your situation.

Preventing infection in the urinary tract
Urostomy patients are at high risk of infections in the urinary tract, because it is not yet possible to completely prevent the return of urine back into the body. We recommend you treat the infection immediately as soon as you notice any symptoms and adopt the following methods for infection prevention:

• Drinking a lot causes constant washing of the urinary tract and dilutes the amount of bacteria. The recommended amount is 10-15 cups of water a day (1.5-2 liters). In the summer you should drink more (unless your doctor says otherwise.) If your urine is dark, you need to drink more.

• Keep your urine acidic to prevent germ growth by:

- Drinking apple juice

- Taking vitamin C

- Eating a handful of cranberries or drinking half or a whole cup of cranberry juice. For diabetics, one capsule. NOTE: people who take blood thinners like Coumadin should not use cranberries.

• Appropriate equipment prevents contact between the urine and the skin and so prevents bacteria growing around the stoma – using a skin guard that matches the stoma diameter (not too big), using protective powder, wipes, sealing rings, a belt. And preventing the return of the urine by using a bag with a no-return mechanism.

• Regularly emptying the bag.

• Using the bag at night.

• If there is an accumulation of crystals (white crystals like salt caused by basic urine) around the stoma, wash the area around the stoma with citrus vinegar only: dilute vinegar and water in equal amounts and using a rag, wet the area around the stoma for a few minutes. Dry it well and stick the skin guard on. The vinegar will not cause any damage to the stoma.

• Routine urinary tract check-ups

 

Identifying infection symptoms in the urinary tract

• Cloudy urine

• Pain in the waist area

• Temperature, dizziness

• Nausea, vomiting

• Basic urine (sharp smell)

• General bad feeling

• Lack of appetite

If you have any of these symptoms, tell your doctor immediately. If left, you could cause damage to your kidneys.

The doctor will diagnose the infection by inserting a sterile catheter into the stoma and sucking urine out for a culture examination. Drugs treatment will be prescribed according to the bacteria growing in the culture. 

General recommendations

Clothing

There is no restriction on what you wear. Just make sure it’s comfortable and there is no pressure on the stoma (eg, a belt, elastic, etc.)

We recommend using special stomach belts which have a cut opening through which the stoma bag can emerge. This kind of belt supports your abdominal muscles and the skin guard (before you buy one though, consult with the stoma nurse.)
 

Nutrition

There is no restriction on what you can eat, but you should know that certain foods affect the smell of your urine, such as fish, onions, garlic, asparagus, various sauces and spices, vitamins and antibiotics.

Make sure you drink at least 10-15 cups of water a day (1.5-2 liters). Coffee and tea are not alternatives for water.

 

Washing

Showering is possible with the skin guard and the bag. You can shower without them but there will always be urine leakage.

You can use any soap that does not contain fats or moisture. Do not shower in very hot water or aim the water directly onto the stoma.

Swimming is permitted three months after surgery. You can use a waterproof band for strengthening the base. Best to empty the bag before entering the water. Do not bathe in the Dead Sea.

Removing hair around the stoma should be done carefully using sharp scissors, a shaver, or special cream.

 

Physical Exercise

For three months after the operation, you should avoid lifting heavy objects, and refrain from stomach muscle exercises and strenuous exercise (light walking is okay.) This is to allow the surgical wound to recover properly. You can gradually return to all the activities and hobbies you enjoyed before the surgery in keeping with your abilities. We recommend using a supportive belt and to avoid sport that involves close contact so as not to damage the stoma.

 

Work

Your doctor will give you guidelines about going back to work.

Driving

No problem. Just make sure the seatbelt is not pressing on the stoma.

 

Social Support

Sometimes, the patient and his family often find it hard to get used to the treatment and return to their basic daily routines. You can use the services of the social worker in the department, who will check whether you are entitled to any rights or services that can help you. You can get other information from the National Insurance Institute and from the Organization for Stoma Patients in Israel. Taking part in a support group is also a good idea.

 

Travel and trips

With a little advance planning, you can go anywhere. Calculate the amount of equipment you will need for the duration of the trip and add extra for unexpected situations. For overseas trips you can obtain a special border pass for stoma patients from the Israel Cancer Association or from the companies who supply your stoma equipment. More information is available on the International Ostomy Organization website.

 

There are countries and places in which the water is not suitable for drinking. Do not wash your stoma with that water either.

 

Sexual Relations

Any return to sexual activity should be done gradually, with sensitivity for your own feelings and concerns and those of your partner.

 

Negative emotions are a normal reaction to the internalization process and accepting the new stoma reality.

 

Sexual functioning can be impeded as a result of the stoma, either for emotional and psychological reasons or for physiological reasons such as damage to the nerve responsible for erection or the woman’s ability to lubricate. The ability to sense and sensitivity to touch are not affected and sexual activity does not affect the surgery or the stoma itself.

 

It is important to speak openly with one another, and with the stoma nurse in the hospital or in your kupat holim. There are solutions to these changes and challenges.

 

The Israel Cancer Association has an advisory service for sexual and body image issues. It is free of charge, with no need for medical referral. You do need to make an appointment in advance. Call 03-5721643 and leave your details.

 

Before discharge

Before you leave the hospital, we make sure you will be able to integrate your stoma treatment into your everyday life. Our stoma coordination nurse will contact your local stoma nurse so that she can continue to help you with your particular needs.

 

It is also important to inform your regular family doctor and kupat holim nurse that you have undergone this surgery.

 

When should you contact your urologist?

• When there is a significant change in the color of your stoma (becomes blacker). Report immediately to the ER.

• Contact your doctor when:

- You notice a significant drop in the amount of urine.

- The stoma size changes dramatically

- Your urine emits a sharp smell (one that cannot be attributed to a particular food you may have eaten, such as garlic, onion, certain vitamins or antibiotics) and looks cloudy. You may also have a temperature or feel dizzy.

- Pain in the kidney area.

- Pain in or around the stoma.

- Blood in the urine.

Of course, you should schedule routine check-ups with your doctor irrespective of any of the above.

 

When should you contact the stoma nurse in the community/in the hospital?

• When you experience ongoing urine leakage through the skin guard.

• When your skin is itching around the stoma (or you experience burning, rash, redness).

• When there are problems in equipment supply.

• When you want to change your supply company.

• When you need additional guidance, encouragement or just someone to listen.

 

If you have any questions, please contact Mrs. Yochi Kand, Shaare Zedek’s Stoma Coordinator, in the mornings from Sunday-Thursday – 050 8685853, or the Urology Department on 02-6666256, 02-6555556.