Urostomy types

Urostomy types

Surgically created urostomies

This group includes urostomies that do not hold urine (open) and ones that do (so called continent or tight urostomies).

Urostomies that do not hold urine:

Bricker ileal conduit (ureterocutaneostomy)
The stoma is created by bringing the end of the ileum through the opening in the rectus abdominis muscle. The formation of the stoma cone, protruding about 1-2 cm above the skin surface level, protects against the occurrence of a parastomal hernia and facilitates the fitting of the urostomy equipment. The stoma outlet should allow two fingers to pass freely. A tight anastomosis of the ureters and the terminal ileum reduces the risk of their obstruction and leakage. According to numerous reports, a radical cystectomy with subsequent urinary diversion, consisting of the reconstruction of the removed bladder by means of the intestine, belongs to the most extensive urologic surgeries and to the largest surgical procedures within the abdominal cavity.

In men, the surgery involves the removal of: prostatic gland together with seminal vesicles and regional lymph nodes; in women: the uterus and appendages, the front wall of the vagina and regional lymph nodes. The outlet of the stoma on the abdomen is usually located around 4 cm from the navel, which is of decisive importance in the subsequent proper functioning of the urostomy and the patient’s self-care. Because in this type of stoma, urine flows out in an uncontrolled way, it is necessary to ensure a permanent supply of urostomy equipment.

It is usually a bilateral connection of the ureters to the skin opening of the stoma on the abdomen. A ureterocutaneostomy is performed by separating a ureter from the bladder (one or both), dissecting it and implanting it into the skin of the abdominal wall. In the early post-operative period, a catheter matching the ureter diameter (usually from 6 to 14 Ch) remains inserted in the ureter outlet on skin. An indication for this type of urinary diversion is advanced bladder cancer or a cancer of the reproductive organ. Sometimes, this is the effect of an adverse intraoperative condition, e.g. massive bleeding. Usually, patients with severely impaired renal function or in severe general condition are eligible for this type of urinary diversion. Quite often, a progressive disease forces the physician to leave the catheters in the ureterocutaneostomy, which involves the necessity of periodic replacement of drains and the use of stoma care supplies.

Cutaneous uretero-ileostomy
This is the definitive anastomosis of the ureters with the cranial end of the isolated intestinal fragment, which forms a conduit whose distal end is connected with the opening on the abdomen skin. Choosing the right section of the intestine to perform this type of stoma depends on several factors. The ileocaecal segment is used for the creation of tight intestinal urinary vessels with an outlet in the abdominal wall. This section of the intestine provides a better design of a low-pressure, high-volume reservoir that allows for easy and safe reflux-preventing implantation of the ureters. What is more, metabolic disorders are rare after this type of surgery. In patients subjected to radiotherapy, only sections of the intestine located outside the irradiated area are used to produce urinary diversion. The modern technique of implanting the ureters to the sigmoid was replaced by a low-pressure rectal reservoir. When planning the location of the stoma with an intestinal insert, the position of the patient’s body when standing, sitting and lying down must be taken into account.

Examples of urostomies that ensure urine holding (so-called tight or continent urostomies) are:

Replacement intestinal urine reservoir
A permanent urine diversion from the intestinal reservoir, replacing the bladder. This type of urostomy is created by implanting the ureters into the reservoir, which is connected to the skin opening of the stoma on the abdomen by means of an intestinal conduit. It is a tight urostomy that provides urine holding and allows periodic emptying of the reservoir by means of a catheter inserted through the conduit.

Vesicointestinal skin fistula
A permanent urinary diversion from the bladder through a conduit made of an isolated loop of the ileum or appendix and connected to the bladder on one side and to the abdomen skin opening on the other side. This type of urostomy ensures urine holding and allows periodic emptying of the bladder by means of a catheter inserted through the conduit.

Urostomies created by percutaneous puncture

They provide temporary or, less frequently, permanent urinary diversion from the bladder and kidney. This group includes nephrostomy, cystostomy and tight cystostomy.

Most often performed by means of kidney puncture through the skin. A nephrostomy may serve as a temporary fistula or permanent way of urinary diversion. Using ultrasound to monitor the pathway of needle insertion into the dilated renal calyx system, the physician introduces a vesicular guidewire and subsequent dilators. After dilating the canal to reach the diameter corresponding to the catheter size, it is placed in the kidney and secured with suture and dressing. Usually, a urinary drainage bag is attached to the catheter.
For detailed information regarding nephrostomy visit: http://www.cortmed-international.com/nephrostomy

Most often performed by means of puncture or surgical placement of a catheter in the bladder. A vesicocutaneous fistula can serve as a permanent solution for a patient. A cystostomy is performed in the following cases: urethral injury, narrowing, inflammation or fistula that prevent urination or the introduction of a catheter into the bladder. Other indications include urinary retention due to prostatic hyperplasia, some forms of bladder dysfunction and neoplastic diseases of the urethra, vulva or genital tract. Using ultrasound to monitor the path of puncture cannula insertion, the physician introduces a catheter into the bladder. A urinary drainage bag is attached to the catheter outlet. The catheter is secured on the skin with an additional suture and dressing. Both nephrostomy and cystostomy are performed using special kits for kidney or bladder puncture with diverse catheter diameters and made of various materials, which affects the subsequent timing of catheter replacement.

Tight cystostomy
A vesicocutaneous fistula with a bladder tightness system. During the surgery, the physician models a fragment of the bladder wall into a tube shape. Its peripheral end is sewn into the abdominal wall, forming the outlet on the skin and ensuring bladder tightness in the periods between episodes of catheterisation. This type of urostomy is most commonly performed in young people who, due to underlying disease, are forced to use self-catheterisation through the urethra. Disposable catheters with the diameter adjusted to the patient is used for this purpose.