What does the procedure involve?
Diversion of urine to skin with an intestinal stoma
What are the alternatives to this procedure?
Catheters, bladder enlargement, continent diversion (a catheterisable pouch), depending on the reason why the stoma is being formed.
What should I expect before the procedure?
You will be seen by a Stoma Nurse Specialist before your operation to discuss life with a urostomy and to try the various drainage bags available. If you wish, you will given the opportunity to meet someone who has previously had this procedure. You will usually be admitted on the same day as your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and your named nurse.
You will be seen by the Stoma Nurse Specialist before your operation to mark the site where your stoma will be positioned. You will also be seen by the anaesthetist before the operation. You will be given intravenous antibiotics at the time the anaesthetic is given, and possibly after surgery too. You will be given an injection under the skin of a drug (tinzaparin) that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the leg veins.
What happens during the procedure?
A full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which produces freedom from pain post-operatively. In the operation, the ureters (the tubes which drain urine from the kidneys to the bladder) are sewn to an isolated segment of small bowel which is positioned on the surface of the abdomen as an opening called a urostomy. The ends of the small bowel, from which the conduit is isolated, are then joined together again.
What happens immediately after the procedure?
The average stay in hospital will last approximately 10-14 days. Drainage tubes will be placed through the stoma up to the kidneys, for about 8-10 days. There will be a drainage tube close to the wound, to drain fluid away from the internal area where the operation has been done. A tube may be placed through the nose to drain the stomach.
After your operation, you may be in the Intensive Care Unit or the Special Recovery area of the operating theatre before returning to the ward; visiting times in these areas are flexible and will depend on when you return from the operating theatre. You will have a drip in your arm and you may have a further drip into a vein in your neck.
You will be encouraged to mobilise as soon as possible after the operation because this encourages the bowel to begin working. We will start you on fluid drinks and food as soon as possible. Normally, we use elastic stockings to minimise the risk of a blood clot (deep vein thrombosis) in your legs.
A physiotherapist will come and show you some deep breathing and leg exercises, and you will sit out in a chair for a short time soon after your operation.
You or your carer will be shown by the stoma care nurse how to empty and change the stoma bags, and you or your carer will be confident doing this before you go home. It will, however, take at least 3-6 months for you to recover fully from this surgery, although much of the recovery comes a good deal sooner than this.
Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
You will be at higher risk of having recurrent urinary infections after surgery, and you may require long-term antibiotic treatment. The function of the kidneys may decrease with time.
Less commonly, anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death) may occur. There is a small risk of needing a blood transfusion. You may develop a hernia at the urostomy site, and this sometimes requires further surgery. You can develop diarrhoea/vitamin deficiency/constipation due to shortened bowel, requiring treatment. Scarring of the bowel or ureters requiring further surgery can occur.
What should I expect when I get home?
When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
You will require pain-killing tablets at home for two or three weeks and it may take two or three weeks at home to become comfortably mobile. You should avoid driving for at least six weeks, and it may be longer before this is possible. If you work, you will need a minimum of six weeks off, and it may be significantly longer if your work involves physical activity. Heavy lifting should be avoided for 6 weeks. Sexual intercourse should be avoided for at least a month. You may see blood in the urine or vaginal discharge for up to a month after surgery.
What else should I look out for?
There are a number of complications which may make you feel unwell and may require consultation with your GP or contact with Newcastle Urology. If you experience fever or vomiting, especially if associated with unexpected pain in the abdomen, you should contact your doctor immediately for advice.
Are there any other important points?
The Stoma Care Nurses will keep in contact by phone and by clinic visits in the first couple of months after surgery, and be available for long-term follow-up. A follow-up outpatient appointment will be arranged at about 10-12 weeks after surgery.
