What to Expect With a Urostomy (2025)

A urostomy is a surgical procedure that creates an artificial opening in the abdominal wall, called a stoma, to reroute urine flow. A stoma may be necessary when the bladder is diseased or does not work as it should (this can happen due to conditions like bladder cancer or a bladder nerve injury).

The urine is collected in a bag worn outside the body, called a urostomy bag, or drained with a catheter. A specialized nurse, known as an ostomy nurse, will show you how to care for your stoma and properly drain and replace a urostomy bag to protect your skin from irritation and infection.

Reasons to Have a Urostomy

A urostomy (urinary diversion) may be performed when your bladder is no longer working properly, or you cannot pee through your urethra (the tube through which urine exits the body).

There are five major indications for a urostomy:

• Bladder cancer
• Neurogenic bladder (loss of bladder control caused by nerve damage)
• Anatomic differences present at birth, such as spina bifida (a spinal cord malformation) and bladder exstrophy (the bladder forms outside of the body)
• Urinary tract changes, such as due to traumatic injury to the urethra and surgeries for other cancers

Types of Urostomy

Incontinent Diversion

Incontinent diversion involves creating a small pouch (ileal conduit) using a section of the small intestine. The pouch collects urine from the kidneys and then passes it out of the body through the stoma.

With an incontinent diversion, the flow of urine cannot be controlled, and you will need to wear a urostomy bag at all times.

Incontinent diversion is a relatively common procedure that is often performed alongside the surgical removal of the bladder (cystectomy).

Continent Diversion

Continent diversion involves creating an internal pouch as a temporary urine reservoir. Unlike an ileal conduit, the pouch has valves to keep the urine from backing into the kidneys or spilling out of the stoma.

An external urostomy bag is not necessary for a continent diversion. Instead, the urine is drained from the internal pouch four to five times daily using a flexible tube known as a catheter.

Several surgical techniques are used for continent diversion:

• Kockpouch (K-pouch): This procedure, similar to an incontinent diversion, involves creating an internal pouch using a piece of the ileum and a stoma. A surgical flap is then fashioned, which shuts like a valve whenever the pouch fills with urine.
• Indiana pouch: This procedure creates an internal pouch using a piece of the large intestine and the ileocecal valve, naturally found inside the intestine. Urine flow is rerouted through the abdominal wall via the ileum to a stoma.
• Ileal neobladder: Also known as a bladder substitute, this involves creating an internal pouch from the ileum. The pouch reroutes urine through the urethra rather than to a stoma. The pouch acts as a replacement bladder without the muscles pushing urine into the urethra.

Continent diversion is technically more complicated to perform than incontinent diversion. Most surgeries take at least six hours to complete.

How a Urostomy Bag Works

If you undergo an incontinent diversion, you will need a urostomy bag. These bags come in many sizes and shapes. Both of their two main systems involve an adhesive barrier that sticks to the skin and a collection bag into which urine drains:

• One-piece systems combine the adhesive barrier and collection bag. When the pouch is removed, the barrier also comes off.
• Two-piece systems have an adhesive flange that you wear on your skin. You can then attach a separate collection bag with a twist or a series of snaps and remove it when it is full.

Reusable closed-end disposable and drainable bags outfitted with a spout or valve are also available.

Night drainage urostomy bags use gravity to drain urine into a collection bag on the side of your bed frame. This allows you to sleep without concern about the bag becoming so heavy that it detaches or leaks.

A urostomy bag should:

• Stay secure and leak-proof for three to seven days
• Be easy to take off and remove
• Allow you to shower or bathe with the bag on
• Be odor-resistant
• Be nearly invisible
• Protect the skin around the stoma

An ostomy nurse can help you select the best option for you and teach you how to properly care for and maintain your urostomy bag and stoma.

Bag Maintenance and Care

When properly fitted, a urostomy bag will limit urine exposure to the skin. Prolonged exposure can cause irritation and pain and increase the risk of a local infection.

To ensure the proper fit, the opening of the adhesive barrier should be no more than 1/8-inch larger than the size of your stoma. Many barriers allow you to cut a hole with scissors to match your stoma's size and shape.

An ostomy belt or tape can be used to keep the bag stable and reduce its appearance under clothing. These appliances help reduce the risk of detachment and leakage if the bag gets overly full. An ostomy nurse can show you how to use a urostomy belt or tape so that it doesn't compress and injure the stoma.

When it is time to remove the urostomy bag:

1. Wash your hands with plain, non-fragranced soap and water.
2. Empty closed-end bags over the toilet by openingthe spout or valve at the bottom of the bag.
3. Use water or a commercial adhesive remover to loosen the adhesive seal. Disposable bags can usually be peeled off and thrown away.
4. Wash and thoroughly dry the skin around the stoma.
5. If the skin around the stoma is irritated, sprinkle some ostomy protective powder and gently blot it. These powders, found online or in drugstores, are unnecessary when the skin is healthy.
   
6. Use scissors to size the opening of the adhesive seal.
7. Apply a thick ring of ostomy paste around the seal of two-piece systems. Most one-piece systems have peel-away adhesive strips.
8. Apply the adhesive barrier to the skin.
   

If you have used a closed-end bag, clean it with warm water or a mixture of 1/4 cup white vinegar and 1 cup water. After washing the bag, let it air-dry completely.

Urostomy With Catheter Drainage

A continent diversion does not require a urostomy bag. Instead, it involves using a urinary catheter—either a straight (standard) catheter or a Foley catheter—to drain the internal pouch four to six times a day.

Straight Catheter

Straight catheters are inserted into the stoma after a K-pouch or Indiana pouch procedure. You will insert the catheter into the stoma and use a syringe attached to the end of it to empty urine from the internal pouch. Then, you will fill the syringe with sterile water, flush the internal pouch, and empty it of the water.

Foley Catheter

A Foley catheter, also known as an indwelling catheter, is inserted into the urethra and worn continuously after undergoing an ileal neobladder procedure. You may need the catheter only until you are healed, although some people may need one on an ongoing or permanent basis.

During recovery from neobladder surgery, a Foley catheter requires flushing and irrigation three to four times daily to prevent infection.

After you have healed, learning how to pass urine naturally can take time. You can start by going to the bathroom regularly and practicing the Valsalva maneuver, in which you hold your breath and bear down like you are trying to make a bowel movement. With practice, many people can learn to urinate independently without needing catheters.

Over time, the neobladder will stretch and hold more urine, reducing the risk of bladder leakage and incontinence.

Follow-Up Appointments After Surgery

After undergoing a urostomy, you may experience incisional or abdominal pain and may require oral pain medications for up to two weeks. There may also be blood in your urine for the first few days and a slightly pinkish color for up to three weeks. All of these things are normal.

During recovery, you will need to avoid strenuous activity and lifting anything more than 5 pounds (including groceries and small children) for up to four weeks. Driving will also be restricted.

Most people undergoing urostomy can return to work and normal routines within four to six weeks. However, six to eight weeks may be necessary for a full recovery. While recovering, you will work with an ostomy nurse to learn how to care for your stoma and avoid complications like hernias or infections.

Follow-up care is essential to your recovery. This usually starts with a two-week follow-up appointment to remove any stents that may have been used to drain your wound. Additional visits will likely be scheduled, mainly if a cystectomy is performed.

Summary

A urostomy is a surgery that redirects the flow of urine from the bladder to an opening in the abdominal wall. This includes an incontinent diversion in which urine passes into an external bag or a continent diversion in which urine passes through a catheter without a bag. A newer option, called an ileal neobladder, diverts the flow directly to the urethra rather than the abdomen.

After the surgery, an ostomy nurse will be assigned to teach you how to care for your stoma and change your urostomy bag or catheter.