There are two kinds of urostomy surgery termed urinary diversion. The name of this diversion is given on the basis of pathways of urine diverted from the bladder. The two main diversions are:
Incontinent diversion, often termed as standard or conventional urostomy.
Continent diversion, often called a continent urostomy or continent urinary reservoir.
Incontinent diversion:
This type of diversion is performed in case of bladder cancer, any birth defect, or chronic illness.
An ileal conduit is created for this type of urostomy. A small pouch that holds the urine is called an ileal conduit. It is created by using a small portion of an intestine.
A 6 to 8-inch piece is taken from the lower part of the ileum and cut at the point where it connects with the large intestine and the other region of the ileum is then re-attached with the large intestine. Then the ureters are disconnected from the bladder and connected with the part ileum that was removed. In some cases, the bladder may be removed and in some cases, it remains safe. The last end of the part of the ileum serves as a stoma. And the other end is used to make a pouch or a pocket inside the body that stores the urine. This surgery is life lasting and the patient can’t control his urine. The patient needs to wear an Ostomy bag all the time.
The small intestine has a natural ability to produce mucus. The part of the ileum that was used in the production of the urine pouch will also continue to produce mucus. This mucus will be collected in the pouch along with the urine. There is nothing to worry about this.
Continent diversion:
In this type of surgery, the surgeon needs to create a pouch too. But in this case, the pouch has an addition in the form of valves. These valves prevent the backflow of the urine until it passes out of the body. A catheter is used to drain this pouch 4 to 5 times daily. Your doctor or Ostomy nurse can guide you about the usage of catheters and drainage of the pouch.
Types:
There are many types of continent diversion surgery depending on the parts that are used to make the pocket or the pouch.
End of the small intestine is used to make the pouch, valves, and outlet.
Indiana pouch:
Ascending colon(large intestine) is used for making the pouch. The last part of the small intestine is used to make the outlet. And in this surgery the natural illoce
Valve is used.
Mitrofanoff Procedure:
This procedure offers different choices. The surgeon can use the bladder, large, small intestine or both for making a pouch. And appendix, fallopian tube, or any part of the ureter is used to make the outlet.
Illeal neobladder:
The ileum is used to make the pouch. In the case of a neobladder, there is no Ostomy performed. The urine simply passes through the urethra. You will not feel the urge for urinating normally so you must make a schedule for urination.
Types of Pouches:
There are different styles and sizes of Ostomy pouches. You can ask help from your Ostomy nurse for the selection of pouch according to your condition. All the pouches involve a collection pouch that is used to collect the urine and an adhesive barrier that gets attached to your skin. This barrier is often called a flange. There are basically two pouching systems.
One-piece pouch: It consists of a pouch and skin barrier both connected together in the same place. When the patient removes the pouch the barrier also gets removed.
Two-piece pouch system: It has a pouch and a separate skin barrier. When the patient removes the pouch and the barrier remains in its place.
During your stay in the hospital, following the surgery, the nurse can guide you about the pouching system and its selection. Some patients can use this pouch throughout the life and some may need to jump to another pouching system in case of weight gain or any other reasons. It’s not necessary to stick with the recommended pouch if you are not comfortable with it. You can try various types till you get the best one for you.
What is a skin barrier?
There is a constant flow of urine following the surgery that can irritate the skin around the stoma. This can be avoided by using the skin barrier that comes along with the pouching system. It is very gentle and protects the skin from urine and itching. Some brands offer the barrier with a cut but sometimes you need to make a cut according to the size of your stoma.
The stoma looks swallowed just after the surgery, but with the passing days, it will get shrink. During these 6 to 8 weeks the stoma must be measured. There is a possibility that you get a measuring card along with the pouching system otherwise you can create your own. 1/8 inch is the standard size for the orifice on the skin barrier, otherwise, it will be difficult to avoid urine off the skin,.
It totally your choice of you wants to wear an Ostomy belt in order to keep the pouch in place. The belt serves as a wrap around your waist and gets attached to the pouching system.
Using Ostomy belt or tape:
Some people consider it a good choice because they feel more secure and organized. And some people find it embarrassing and they prefer to use tape rather than the belt. The tape can be used just like a frame around the skin barrier in order to prevent the movement of the pouching system.
A pouching system is used to collect the urine and skin barrier is helpful in preventing the urine to touch the skin,
Selection of a pouching system:
It is recommended to consult with an Ostomy nurse or any person who is a certified Ostomy caretaker while choosing your pouching system for the first time.
While you are ready to leave the hospital it's good if you get a referral of an Ostomy nurse or an expert in order to contact them in the future. This will help you to take better care of yourself.
There are many factors such as the size of your stoma, shape of abdomen, scars, or folds near the stomal skin that should be revised while selecting a pouching system. The stomas with the location on hipbone, groin, or wounds need special consideration for the selection of the pouching system. Some brands offer products that can be used in any situation.
The qualities of a good pouching system are:
Have a good seal that prevents leakage for 7 to 8 days.
Odor resistant
Provide protection to the parastomal skin
Hardly seen under the clothing
Easy to wear and put off
Enables you to have a shower or bath wearing them
Factors that can affect the pouching system seal
It is important that the pouching system sticks with your skin properly. It must be changed before any kind of leakage or loosening. Factors such as skin type, scars, weight, climate, diet and activities decide the time period of the pouch to remain sealed. Other factors that can affect the sticking of the pouch are:
The number of days you can wear a pouch depends on the sweating. Sweating can shorten this period. The heat released by the body will loosen the pouch and let it detach quickly.
The skin type that is oily or moist can also, reduce the wearing time period.
Following surgery, there might be a change in your weight. This can also affect the time period of a pouch to remain stick
Application of drainage bag at night:
You can use a night drainage system if you want to be undisturbed during the night. This system is connected with your pouch system that allows urine to pass through the stoma and enter the drainage bag continuously over the night. It prevents the outburst or removal of your stoma pouch. It also helps to protect the kina and stoma from urine pressure.
You should leave a little urine in the pouch before connecting it with the drainage bag. This will prevent the occurrence of a vacuum. Only one inch of the tube should be allowed to enter the bag and should be hanged above the bag. If the urine starts to flow back into the tubes it will stop draining. You can hang a drainage container on the side of your bed.
You can also use a small dustbin. The tubing and drainage collector should be clean regularly. Use vinegar and water mixture for cleaning purposes. More instructions are provided with drainage systems
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