Urostoma

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Classification according to ICD-10
Z93.- Presence of an artificial orifice (excl .: artificial orifices that require observation or care → Z43.-)
Z93.5 Presence of a cystostoma
Z93.6 Presence of other artificial orifices in the urinary tract (including: nephrostoma, ureterostoma, urethrostoma)
ICD-10 online (WHO version 2019)

The urostoma (from the Greek στὁμα stoma "artificially created gap", "mouth" or "opening", also "artificial bladder outlet") is a surgically induced, permanent drainage of urine through the skin to maintain the continuity of the urinary drainage. The corresponding operation is called urostomy and is usually performed by a urologist .

The creation of a urostoma becomes necessary when the urinary system is no longer able to release urine to the outside. This can happen, for example, if the urinary bladder as a reservoir cannot be preserved or the urinary tract is damaged or has to be shut down or removed. Possible causes for this can be congenital malformations, atresia , stenosis of the urinary tract, nerve damage, tumors , but also acquired causes, such as the consequences of radiation therapy , surgery or injuries.

Surgical procedure

Ureter-skin drainage

Depending on the disease of either or both ureter individually inserted (Ureterocutaneostoma, Harnleiterhautfistel) or connected to each other ( T rans u Retero u Retero c utaneostoma, TUUC) was passed through the abdominal wall to the outside. The creation of a ureter skin drain can be performed as a minimally invasive therapy. The resulting opening (stoma) lies flat in the abdominal wall, often tends to scarring and narrowing and may have to be kept open with an indwelling catheter (hollow splint). This tube fixes itself in the renal pelvis with its pigtail end, but has to be changed by the urologist every 6–8 weeks. In the case of bilateral ureterocutaneostomy, both fistulas must each be provided with a supply system that collects the continuously draining urine in a bag. The urostomy is by a specialist for urology created surgically.

Conduit

Schematic representation of an ileum conduit

With this type of stoma ( conduit ; from Latin conducere , “to lead”, “to merge”) a 12 to 15 centimeter long piece of the intestine is cut off and both ureters are sewn into this disused part of the intestine. The surgeon closes the piece of intestine on one side, the other end is diverted as a stoma in the lower abdomen and sewn into the abdominal wall slightly protruding . The separated piece of intestine thus serves as an artificial connection between the ureters and the (upper) skin ( stratum disjunctum ). In the first time after the operation, ureter splints - ureter splints - ensure that the inner seams can heal well and that urine excretion is even . The splints are usually removed during the hospital stay.
Outwardly, a conduit resembles an enterostoma (artificial anus).

Depending on the section of intestine used, a distinction is made between an ileum conduit (using a section of the ileum) and a colon conduit (using a section of the colon). Like the ureter skin drainage , a conduit must be supplied with an external bag system, which is why the conduit procedure is also called bladder replacement with loss of continence .

Wet colostomy

A moist colostomy can be considered if the bladder and rectum are no longer used as excretory organs. The colon (colon) is evacuated in two ways. The oral thigh supplies stool to the stoma; the ureters are implanted in the aboral, blindly closed thigh. A mixture of urine and stool evacuates from the double-barreled stoma.

Continents urostomy

In these urostomies, a pouch made from different parts of the intestine (only small intestine or from parts of the small intestine and large intestine) serves as an inner urine reservoir ( neo-bladder ), which ends in a tightly closing stoma in the lower abdomen or in the navel. Depending on the intestinal parts used and the technology used, the term Kock-Pouch, Mainz-Pouch, Indiana-Pouch etc. is used. The patient empties the reservoir directly into the toilet using a catheter (usually 3-4 hours, including at night).

Possible risks and complications

In rare cases, injuries to the intestine, neighboring organs or vessels can occur during the operation. Urine leaks are also possible. If a seam connection in the intestine leaks, serious consequences such as peritonitis , blood poisoning , intestinal paralysis (intestinal atony), intestinal obstruction and others can develop. In rare cases, fistulas can form, particularly as a result of infections .

Unpredictable circumstances such as extensive adhesions in the abdominal cavity or anatomical peculiarities may require a change or expansion of the planned operation.

As specific stoma complications included the withdrawal of the stoma below the skin level (are retraction ), prolapse of the stoma ( prolapse ) and abdominal hernia ( hernia to name).

A stoma is sensitive so it may bleed lightly if you touch it, which is not a concern. Serious bleeding, on the other hand, requires a medical examination. A black discoloration of the stoma can indicate the onset of necrosis that requires immediate treatment.

In the case of the conduit, increased mucus formation can occur, especially in the first time after the operation. The small piece of intestine to which the ureters were attached continues to produce mucus. This then appears in the urine, which is harmless and wears off over time. If the mucus builds up within a short time, it should be ensured that the change is not due to a urinary tract infection.

In particular, the ureter skin drainage method offers the potential for further complications because of the consistently lying splint. Pathogenic germs can quickly rise from the outer skin along the splint to the renal pelvis. In the long term, kidney function can therefore be restricted by constantly new or recurring infections. The splint does not completely convey the accumulating urine. Remnants run down next to the tube in the ureter and emerge at its mouth, which can lead to irritation. When changing the supply there is always the risk that the splint will slip.

When supplying the conduit and also during self-catheterization, faecal germs that are transferred from the patient's own anal region via smear infection cause similar problems. Overall, however, infections are less common.

If the person concerned develops a fever, a urinary tract infection must always be considered.

Regular care by an enterostoma therapist can help prevent complications and clarify important questions. Corresponding contact persons can be found via the FgSKW Fachgesellschaft Stoma Kontinenz Wunde eV or via the Deutsche ILCO eV .

The stoma supply

An ostomy supply always consists of a base plate to be glued to the abdominal wall and a bag attached to it, which is used to hold the excretions. A distinction is made between one and two-part systems. In the one-piece systems, the base plate and bag are firmly connected to one another and can only be changed together. Two-part systems are characterized in that the base plate and bag are separate units, which means that the plate is glued and the bag is subsequently connected to it by means of a locking ring or adhesive surface. The two-part supply system allows the plate to remain on the stomach when the bag is changed for hygiene reasons. The base plate remains on the stomach for 3-5 days and the special urostomy pouch is changed regularly every 24 to 48 hours.

When treating a urostomy, only special urostomy bags with a drainage opening (so-called open system ) are used, which must also be provided with a backstop to avoid infections. The urine collected in the bag is emptied through the drainage opening at the lower end of the collecting bag. Overnight, the connection with a night bag ensures that the urostomy bag remains empty in a horizontal posture.

After removing the old supply, the skin area around the stoma is only cleaned with water and compresses, after which the new system is applied. Hair around the urostoma can be removed with fine scissors or disposable razors. After individually cutting the opening in the base plate, the new restoration is glued on. It is important that the cut is accurately fitted so that urine does not infiltrate the plate.

The use of a convex fitting ensures a greater degree of sealing if, for example, a conduit has been created at or even below the skin level. In general, the skin protection plate is max. Leave on the skin for 2-3 days. At longer intervals, the material is swollen with the urine and no longer protects the skin. Inflammation of the skin with subsequent scarring and also ascending urinary tract infections can result in too infrequent supply changes.

To avoid the spread of germs, urostomy patients should only bathe with full supplies and then change them.

Drinking enough fluids is the top priority to prevent infections.

Sports, work and other activities

A well-designed stoma hardly limits life. Sport, work and sexual activities are quite normal. To prevent a hernia , however, you should not lift significantly more than 10 kg. Sports with physical contact such as martial arts endanger the stoma. Specialist shops have special abdominal ties, protective caps and swimming belts that can provide additional protection for the stoma and stoma supply during sport or at work.

Pregnancy carries the same risks for ostomists as it does for any other woman. Many young women with an ostomy experience a completely uncomplicated birth. There are only restrictions here on the basis of the previous illness or if a double-barreled stoma is created.

On presentation of a severely handicapped ID card or a medical certificate, ostomists can purchase the so-called Euro key from the CBF Darmstadt eV . The key fits on motorway toilets, toilets for the disabled in many cities in Germany, Austria, Switzerland and already in some other European countries. A hygienic plate change in clean sanitary facilities is possible at any time.

When traveling long-distance, it is advisable to have the international travel certificate drawn up by the self-help association of European ostomists signed by the doctor. It educates foreign authorities and airport staff about the stoma and prevents the stoma from being removed for inspection without a doctor being present. When traveling, you should also take twice the amount of supplies with you, as there may be minor conversion problems. Taking it with you in hand luggage ensures that the supplies arrive at the holiday destination even if the suitcase makes a detour.

See also

literature

  • Thomas Bölker, Wolfgang Webelhut, Tabea Noreiks, Franz Raulf von Schmücker: Through thick and thin. The book for stoma care and urinary diversion. Schmücker, 2003, ISBN 3-9805493-2-1 .

Web links

Individual evidence

  1. ↑ a b c d German ILCO eV
  2. ↑ a b Fachverband Ostomy und Inkontinenz eV ( Memento from November 13, 2007 in the Internet Archive )
  3. ↑ FgSKW professional society ostomy continence wound eV
  4. ↑ CBF Darmstadt eV
  5. ↑ Travel certificate (PDF; 11 kB).