UROSTOMY

Urostomy - Urinary Tract Opening, Urinary diversion

A urostomy is simply an artiicial opening in the urinary tract on the body surface. On occasion, it may be a direct opening from the ureters or bladder, but by far the commonest urostomy is the ileal conduit. This form of urinary diversion has been popular for many years as a means of solving the problem of what to do when the bladder is lost through accident or disease or when it does not develop its normal function or control.

The ileal conduit uses a short segment of the small bowel, isolated from the rest of the bowel but with its blood supply intact, to provide a means of conveying urine from the ureters to the outside collecting appliance. To one end of this short piece of bowel the ureters are attached and the other end is brought through the abdominal wall to form a stoma. The stoma is fashioned as a spout to allow a collecting appliance to be fitted and to prevent urine coming into contact with the seal of the appliance to the abdominal wall. Urine is produced continuously down the ureters into the bowel segment and hence to the outside. Intermittent contractions of the bowel segment, in an ordered fashion, called peristalsis, aid the passage of urine along the conduit and lead to the urine being discharged from the stoma in small spurts, at fairly regular intervals.

Whether the bladder is removed or remains is of no signiicance to the function of the ileal conduit. The person’s own bladder may need to be removed because of the disease process that destroyed it, or it may be left behind as a functionless organ that is now no longer in use. Because of the success of urostomy appliances in providing leak-free systems, an ileal conduit may the best way of managing an otherwise unmanageable incontinence. Occasionally an internal pouch is formed on the inside of the abdomen using a segment of bowel and is emptied by intermittent catherization.