Urostomy (ileal conduit)

A urostomy is a way of collecting urine through a bag outside your body. It is also called an ileal conduit. This operation is usually part of the surgery to remove your bladder (cystectomy).

After the surgeon removes your bladder you need another way of collecting your urine. This is called a urinary diversion. There are different types of urinary diversion. The most common is to have a urostomy.

The surgeon creates a new opening (stoma) in the skin of your tummy for your urine to pass through.

After a urostomy, you pass urine through an opening (stoma) in your tummy (abdomen). You wear a bag at all times to catch the continuous flow of urine.

Why you might have this surgery?

Your surgeon might ask you to choose which type of urinary diversion you have. Or they might recommend one type of diversion over another because of where your cancer is. Or because of your general health.

Your surgeon might suggest a urostomy if:

you are older - there isn't a precise age guideline, but your doctor will probably recommend this type of surgery if you are older than 80
you have other health problems - this type of diversion may be less risky for you than other types
your cancer is in your urethra - this is the tube that carries urine from the bladder out of the body
your kidney or liver function isn't very good
you might find it difficult to care for other types of urinary diversion - for example, self catheterisation or passing urine with a new bladder

Your surgeon and specialist nurse will support you before and after your operation. They will tell you about the different options and whether one type might be best for you. And they will show you how to look after and manage the type of urinary diversion you have.

What happens

Your surgeon makes the urostomy during the operation to remove your bladder (cystectomy). You have this operation while you’re asleep under a general anaesthetic. The operation takes between 4 and 6 hours.

The urologist removes a short piece of your small bowel (ileum). They join the cut ends of the ileum back together.

The surgeon then sews the tubes that carry urine from your kidneys (the ureters) into one end of this piece of ileum.

Next, the surgeon cuts a small hole in the surface of your tummy (abdomen). They then bring the other open end of the piece of ileum out through this hole. This makes a stoma. The stoma is usually put to the right of your tummy button (navel).

After the operation, your urine runs down the ureters, through the piece of ileum. The piece of ileum is like a channel (conduit) that carries the urine to the stoma and out of the body. This is why the operation is also called an ileal conduit.

Diagram showing how a urostomy is made (ileal-conduit)

After your urostomy

When you wake up from surgery you’ll have a lot of tubes attached to your body. You might have a drip, wound drain and ureteric stents. These are thin tubes that drain the urine from your ureters into the urostomy bag. They stay in place whilst the ileal conduit heals.

Your stoma

The stoma looks like a small spout sticking out of your abdomen. It is red like the inside of your mouth. It does not hurt because it has no nerve supply.

The stoma is swollen just after your operation. It gets smaller as it heals. It produces a thick white mucus, which collects in your bag along with the urine. The amount of mucus gradually lessens over time, but it will always produce some mucus. This is normal.

Urostomy bag

You'll have a waterproof bag (urostomy bag) over the stoma to collect the urine. The bag sticks over the stoma. The bag can stay in place for a few days at a time. It has a tap or bung at the bottom of the bag so you can empty it into the toilet.

At first the nurse will look after your urostomy for you. They will teach you to care for your stoma. And they will show you how to empty and change your urostomy bag yourself.

Problems after surgery

There is a risk of problems or complications after any type of operation. We have a separate page about general problems you might have after surgery to remove your bladder and urinary diversion.

You might have one or more of the following problems after a urostomy.

Urine infections

Although it is uncommon, you have a higher risk of complications from a urine infection after a urostomy. There are lots of reasons for this. For example, bacteria can get into your urine from the stoma or the ileum. Your urine can flow backwards (reflux) into the kidneys. Or your urine flow might be slower so bacteria has longer to grow in your urine.

Your doctor will tell you to drink plenty of fluids. They will ask for a sample of your urine if you have any symptoms such as:

fever or feeling unwell
pain around your kidneys

Your stoma nurse will tell you about the best way to take a sample of urine from your stoma. You should avoid taking the sample from the urine collected in the stoma bag. The nurse might ask for a sample from inside the stoma, using a sterile catheter. Or you might be able to take a sample by holding a sterile pot under the stoma and catching urine as it drips. Both of these techniques are known as a clean catch.

Your doctor will probably give you antibiotics. It is important that you let your doctor know if you don't feel better or your symptoms get worse.

Bleeding or sore skin around your stoma

You might notice a small amount of blood when you clean your stoma. This is normal as it is very easy to damage the delicate blood vessels. The bleeding should stop within a few minutes.

You must let your doctor know if you notice blood coming from inside your stoma. This can be a sign of an infection. Although less common, it can be a sign of other conditions such as renal stones. Or rarely it might be a sign of your cancer coming back.

The skin around your stoma might become irritated or sore. This can happen for several reasons including:

your urostomy bag not fitting properly
pre existing skin problems such as eczema
frequently removing the bag

Let your stoma nurse know if your skin is sore. They can help you work out why this has happened. And then they can advise you what to do.

Problems with your stoma

Some people can develop a hernia at the site of the stoma. A hernia happens when the bowel or fatty tissue tries to push through an area of weakness in the tummy (abdomen) wall. It can happen on your scar line or around the stoma. You might notice a bulge around the stoma.

You might manage to cope with a hernia by wearing a support belt. But some people need to have surgery to repair the hernia.

Going home

You are usually in hospital for 7 – 14 days after the operation.

Your nurse will give you some urostomy bags to take home. They will tell you how to get the equipment you need when you are at home.

Your nurse is likely to set up an ordering system for you to get the bags from your local pharmacy prescription service. Or from a medical devices delivery service.

Or they might give you a prescription card with details of all the equipment you need. You then you take the card to your GP to get the bags and supplies.

When you collect this from your pharmacy you will then need to show your medical exemption card so you don't have to pay for your stoma equipment.

Your stoma nurse might visit you at home. Or you may have a district nurse visit instead. You will have phone numbers to contact for advice when you are sent home. They are there to help you. So do ask for their help with any questions or difficulties you have.