What is a Urostomy?
A urostomy is a surgical procedure that creates a stoma (opening) in the abdominal wall to divert urine away from a diseased or defective bladder. The urine flows through the stoma into a pouch or bag on the outside of the body. A urostomy bag collects the urine draining from the stoma.
Some common reasons for needing a urostomy include:
- Bladder cancer – The bladder needs to be removed due to cancer.
- Birth defects – Such as spina bifida, which can cause problems with the bladder and urinary system.
- Injury – Severe trauma to the pelvis or spine can damage the nerves that control bladder function.
- Other illnesses – Conditions like interstitial cystitis or tuberculosis affecting the bladder.
During a urostomy, the surgeon creates an opening in the abdomen called a stoma. The two ureters (tubes that carry urine from the kidneys to the bladder) are diverted through the stoma to the outside of the body. A pouching system is then attached over the stoma to collect the urine. This pouching system consists of a one-piece or two-piece ostomy pouch, also called a urostomy bag.
Is a Urostomy Bag Permanent?
For many people, a urostomy bag is a lifelong necessity after bladder removal or urinary diversion surgery. So in that sense, it is permanent in order to keep collecting urine and protect the skin around the stoma.
However, a urostomy may not always be permanent in all cases. Some key factors that determine if a urostomy is permanent or temporary include:
- Reason for the urostomy – Is the original cause able to be resolved or cured over time?
- Type of urostomy – Some types like continent diversions have the chance to be reversed.
- Patient’s age and health – Older patients or those with multiple medical issues are less likely to undergo additional surgery to reverse it.
- Patient’s preference – Some opt to keep the urostomy despite options to reverse it.
Let’s explore these factors affecting the permanency of a urostomy further:
Reason for the Urostomy
Why the urostomy was needed in the first place plays a major role in whether it could potentially be reversed.
- Bladder cancer – If the cancer was localized and had not metastasized elsewhere, a urostomy after cystectomy may possibly be reversed once cancer treatment is complete. But if the cancer was advanced or aggressive, the likelihood of reversing the urostomy is very low.
- Spina bifida – Since this is a congenital birth defect affecting the spinal cord and nerves, a urostomy for spina bifida patients would be permanent and irreversible.
- Bladder injury – It depends on the severity of damage and how well the bladder recovers. Mild injuries may heal to the point of urostomy reversal, while significant trauma often precludes reversal.
- Interstitial cystitis – This chronic bladder condition currently has no cure. Most patients with intractable IC requiring a urostomy would need it permanently.
Type of Urinary Diversion
There are various techniques surgeons can use to create the urinary diversion and urostomy. Some options have better chances for reversibility than others.
| Diversion type | Reversibility potential |
|---|---|
| Ileal conduit | Very low – the ureters are completely detached from the bladder and redirected. |
| Continent cutaneous diversion | Moderate – maintains urine storage and control, allowing possible reconnection to the urethra. |
| Orthotopic neobladder | Highest – tries to mimic normal anatomy so ureters can be reattached to the neobladder. |
Patient Factors
The patient’s individual situation also influences whether reversal of the urostomy may be attempted.
- Age – Older patients are less likely to be candidates for additional reconstructive surgery due to anesthesia risks and healing considerations.
- Health status – Significant medical conditions like heart disease, lung disease, diabetes or obesity increase surgical risks and reduce chances for reversal.
- Personal preference – Some patients opt to keep their urostomy even when reversal may be possible. Reasons can include wanting to avoid more surgery, anxiety over leak risk, and comfort with their current pouching system.
Conclusion
While a urostomy starts out as an irreversible surgery for most patients undergoing bladder removal or urinary diversion, there are some situations where a urostomy has the possibility to be reversed. Key factors are the reason necessitating the urostomy, the type of diversion performed, the patient’s age and health status, and their personal preferences.
However, for many urostomy patients, their stoma and pouching system does remain a permanent part of life after bladder surgery. With proper care and maintenance, most are able to resume full, active lives despite needing urostomy appliances long-term. The external urine collection pouch simply becomes the “new normal” for bladder elimination.
Advanced pouching systems, ostomy care techniques and ancillary products help prevent leaking and skin irritation around the stoma. This allows most urostomy patients to continue working, exercising, traveling and engaging in social activities comfortably with their permanent appliance. Support from ostomy nurses and online forums also helps ease the transition to permanent urostomy life.
While the urostomy itself may be permanent, leading a fulfilling life certainly is not out of reach. With dedication to self-care and adaptation, living with a permanent urostomy bag can become second nature.
Coping Tips for Permanent Urostomy Patients
For those facing a lifelong urostomy, these tips can help make the transition smoother:
- Work closely with your WOC/ostomy nurse – they are invaluable resources for pouching guidance, stoma care, skin protection and lifestyle advice.
- Find a pouching system that fits your body, needs and preferences well. Be open to trying different products.
- Join a support group, online forum or meet with a counselor to get encouragement and advice from fellow urostomy patients.
- Let the urostomy be only one small part of your identity – keep pursuing hobbies, interests and relationships.
- Be patient with the adjustment process – it takes time to get comfortable with pouching routine and stoma management.
- Alert loved ones on how they can best support you in this transition.
- Focus on the positives – a urostomy can relieve urinary symptoms and improve quality of life.
With the right mindset and support, it is certainly possible to thrive with a permanent urostomy appliance. Be kind to yourself through the ups and downs. Each day presents a new opportunity to gain confidence in managing your stoma while still enjoying a full life.