Ureterostomy

What is a ureterostomy?

A ureterostomy is a surgery that redirects your ureters, the tubes that carry pee from your kidneys to your bladder, to carry your pee to a new, surgical opening in your skin instead. This opening is called a stoma. It allows pee to leave your body while bypassing your bladder. You can have surgery on one (unilateral) or both (bilateral) ureters.

Your bladder is the organ that usually holds your pee before it leaves your body. After this surgery, pee flows from your kidney into a pouch worn outside of your body (not to your bladder). You must empty the pouch about as often as you would typically use the bathroom. In children, this may drain into a diaper.

A ureterostomy helps you pee when your bladder has been removed or isn’t working correctly due to trauma, disease or other reasons. When pee can’t leave your body, it can lead to chronic urinary tract infections (UTIs), kidney failure and other complications. In most cases, this surgery is permanent.

A ureterostomy is one type of urinary diversion surgery. These are different ways of surgically redirecting the flow of your pee. Any diversion surgery that redirects your waste to flow out of a new opening in your skin (a stoma) is called an ostomy.

Who gets a ureterostomy?

Your healthcare provider may recommend a ureterostomy when your bladder can’t pass pee normally. Possible reasons include:

• Your bladder no longer works properly due to damage or injury.
• You had your bladder removed (due to cancer or disease).
• Congenital (present at birth) anomalies, such as spina bifida.
• Spinal cord injury.

What happens before a ureterostomy?

Before a ureterostomy, you can expect to have the following tests:

• Kidney function tests to see how your kidneys are working.
• Blood tests.
• Imaging tests, such as an X-ray or an ultrasound.
• Retrograde pyelogram: This procedure is like an IVP, but instead of injecting the dye in your vein, your provider puts the dye in your urethra.
• Computed tomography (CT) scan: This test is a special imaging technique that uses a computer to collect multiple X-ray images into a two-dimensional cross-sectional image.
• Magnetic resonance imaging (MRI): An MRI is a special technique that provides detailed pictures of your kidney and ureters.

A healthcare provider will meet with you before surgery to discuss how you care for your stoma. They’ll decide on a location for the stoma that you can see easily and one that won’t interfere with your belt line or a skin fold.

How is a ureterostomy done?

During a ureterostomy, a surgeon disconnects one or both ureters from your bladder and connects them to a surgically created opening in your skin called a stoma. A stoma can be up to 3 inches wide. It allows waste to pass out of your body.

Because your bladder is no longer part of the urinary process, your pee doesn’t have a place to collect before exiting your body. Instead, it exits your body directly into a plastic pouch that’s attached to the outside of your body around the stoma. The exception to this is if you have a unilateral ureterostomy. In this case, pee from the one ureter still collects in your bladder, while pee from the other side goes out of the stoma.

How does a ureterostomy work?

Your stoma doesn’t have a sphincter, a muscle that allows it to open and close, so it can’t control the flow of your pee. Your new urinary system will work in the following way:

• The pouch is placed outside the stoma (the opening in your abdomen) and collects the pee from your body.
• There are two pieces to the pouching system: a barrier and a collecting pouch. (They sometimes come as one unit.) The square-shaped barrier piece has a hole in the center that fits over the stoma and sticks to your skin. The sticky substance on the barrier is strong enough so that pee doesn’t leak outside of the pouch.
• The pouch attaches to the barrier and collects pee as it leaves your body.

Most people empty the pouch about as often as they used the bathroom before the ureterostomy. Typically, you empty the pouch when it’s about one-third to one-half full. There’s a valve at the bottom to allow the pee to be emptied into a toilet without removing the pouch from the stoma.

At night, you can attach a piece of flexible tubing to the valve on the pouch to allow urine to flow into a larger pouch while you’re sleeping.

Pouches lie flat against your body and are attached securely to the skin. Clothing fits over the pouch and covers it, so it isn’t noticeable to others.

What happens after a ureterostomy?

After your ureterostomy, your healthcare provider will show you how to clean and care for your stoma, the skin around the stoma and the pouch. You’ll also learn how and when to change the pouch.

Do I have to restrict activities after a ureterostomy?

You’ll need to restrict your activities, especially driving and heavy lifting, for the first four to six weeks after your surgery. The wound must heal before you can continue doing strenuous physical activities. When your stoma has healed, you can usually return to your normal lifestyle, including swimming and other water sports. Your provider may recommend that you not participate in full-contact sports, such as football or karate.

How should I take care of the stoma and pouch?

Your provider will teach you how to care for a stoma and how to change the pouch regularly. It’s important that the stoma remain clean and dry. Every day, you should:

• Wash the stoma and surrounding skin with mild soap and water.
• Rinse the area thoroughly.
• Dry the stoma completely.

The pouch must also be changed on a regular basis. You should throw away the old pouch and replace it with a new pouch every five to seven days.

What are the benefits of a ureterostomy?

A ureterostomy helps pee drain through your ureters when your bladder isn’t working as it should. This reduces urinary infections and the risk of kidney damage or failure.

What are the risks or complications of a ureterostomy?

All procedures come with some risk. You should discuss the risks with your healthcare provider before surgery. Some of the risks of a ureterostomy are:

• Infection.
• Bleeding.
• Hernia.
• Redness and swelling or other skin irritation.
• The procedure doesn’t work or fix the problem.
• Scar tissue formation.

When should I call my healthcare provider?

You should watch the stoma and surrounding skin. If any changes occur, call your healthcare provider. Changes can include:

• Rash or redness around the stoma.
• Skin that breaks open or is crusty.
• Sores that develop on your skin.

Skin breakdown may occur where pee leaks between the pouch and stoma.

Because bacteria and germs may easily get into the stoma, it can get infected. Symptoms of infection include:

• Dark-colored or bloody pee.
• Excess mucus in your pee or around the stoma.
• Strong-smelling urine.
• Back pain.
• Fever.
• Nausea and/or vomiting.
• Poor appetite.

If these symptoms occur, you should call your provider.

Are urostomy and ureterostomy the same?

A urostomy and ureterostomy aren’t exactly the same. They both involve changing the way pee leaves your body. There are several types of urostomies. For example, an ileal conduit is one type of urostomy that uses a piece of your small intestine to create a new passage for pee.

Is a ureterostomy the same as a nephrostomy?

A nephrostomy is a procedure to drain pee directly from your kidney using a catheter. Your pee drains from the catheter into a bag outside of your body. Surgeons perform it on people who have blocked ureters. A nephrostomy typically isn’t permanent.

A note from Cleveland Clinic

Life after a ureterostomy can be hard to get used to. You may feel self-conscious that you don’t pee like your family members or close friends. It’s important to talk to your healthcare provider about your concerns. They can help you find support or offer ways to help you cope.

Just know that you’re not alone, because many other people have had a ureterostomy. Try to remember that the procedure can help you live a more fulfilling and longer life.