Urostomy is the generic name for any surgical procedure that diverts the passage of urine by re-directing the ureters (fibromuscular tubes that carry the urine from the kidney to the bladder). There are two basic types of urostomies. The first features the creation of a passage called an "ileal conduit." In this procedure, the ureters are detached from the bladder and joined to a short length of the small intestine (ileum). The other type of urostomy is cutaneous ureterostomy. With this technique, the surgeon detaches the ureters from the bladder and brings one or both to the surface of the abdomen. The hole created in the abdomen is called a stoma, a reddish, moist abdominal protrusion. The stoma is not painful; it has no sensation. Since it has no muscles to regulate urination, urine collects in a bag.

There are four common types of ureterostomies:

    Single ureterostomy: This procedure brings only one ureter to the surface of the abdomen.

    Bilateral ureterostomy: This procedure brings the two ureters to the surface of the abdomen, one on each side.

    Double-barrel ureterostomy: In this approach, both ureters are brought to the same side of the abdominal surface.

    Transuretero ureterostomy (TUU): This procedure brings both ureters to the same side of the abdomen, through the same stoma.

Diagnosis/Preparation

Ureterostomy patients may have the following tests and procedures as part of their diagnostic work-up:

• Renal function tests; blood, urea, nitrogen (BUN); and creatinine.
• Blood tests, complete blood count (CBC) and electrolytes.
• Imaging studies of the ureters and renal pelvis. These studies characterize the ureters, and define the surgery required to obtain adequate ureteral length.

The quality, character, and usable length of the ureters is usually assessed using any of the following tests:

• Intravenous pyelogram (IVP). A special diagnostic test that follows the time course of excretion of a contrast dye through the kidneys, ureters, and bladder after it is injected into a vein.
• Retrograde pyelogram (RPG). x ray study of the kidney, focusing on the urine-collecting region of the kidney and ureters.
• Antegrade nephrostogram.
• CT scan. A special imaging technique that uses a computer to collect multiple x ray images into a two-dimentional cross-sectional image.
• MRI with intravenous gadolinium. A special technique used to image internal stuctures of the body, particularly the soft tissues. An MRI image is often superior to a routine x ray image.
• The pre-surgery evaluation also includes an assessment of overall patient stability. The surgery may take from two to six hours, depending on the health of the ureters, and the experience of the surgeon.

After surgery, the condition of the ureters is monitored by IVP testing, repeated postoperatively at six months, one year, and then yearly.

Following ureterostomy, urine needs to be collected in bags. Several designs are available. One popular type features an open bag fitted with an anti-reflux valve, which prevents the urine from flowing back toward the stoma. A urostomy bag connects to a night bag that may be attached to the bed at night. Urostomy bags are available as one- and two-piece bags:

• One-piece bags: The adhesive and the bag are welded together. The advantage of using a one-piece appliance is that it is easy to apply, and the bag is flexible and soft.
• Two-piece bags: The bag and the adhesive are two separate components. The adhesive does not need to be removed frequently from the skin, and can remain in place for several days while the bag is changed as required.

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