What is a urostomy?

A urostomy is a surgically created opening (stoma) on the abdomen that lets urine leave the body without passing through the bladder or the urethra. The ureters are redirected into a short piece of bowel, which is brought through the skin, and urine drains continuously into a waterproof pouch. A urostomy is usually permanent and is most often created when the bladder must be removed or can no longer work safely.

What exactly is a urostomy?

A urostomy is one type of urinary diversion — a group of operations that reroute urine away from the bladder. In a urostomy, urine leaves the body through a stoma on the abdominal wall rather than through the urethra.

Three things are always true of a urostomy:

• It is a diversion, not a storage system. There is no reservoir holding urine inside the body.
• It drains continuously, because the kidneys produce urine every minute of the day and night.
• It requires a pouch worn on the skin at all times, unless a different type of diversion has been chosen.

Because of the continuous drainage, a urostomy behaves differently from a colostomy or an ileostomy: there is no predictable output pattern to learn, no waiting for the bowel to move, and no way to hold urine in. The pouch simply fills, and it is emptied.

How a urostomy differs from a colostomy or ileostomy

All three are stomas, and all three are pouched, but the similarities end there.

• A colostomy diverts stool from the colon. Output is semi-solid or solid and is usually predictable in timing.
• An ileostomy diverts stool from the small intestine. Output is liquid or paste-like and frequent, and it contains digestive enzymes that can irritate skin.
• A urostomy diverts urine. Output is liquid and continuous, and it is usually sterile when it leaves the kidney but becomes alkaline on contact with skin.

That last point matters practically. Urine is far less damaging to skin than ileostomy output, but it is present all the time, so a small leak that would be trivial for a colostomy will, within hours, start to break down the skin around a urostomy. A good seal every time is the whole game.

The words you will hear: stoma, conduit, diversion

Urostomy care comes with its own vocabulary, and clinicians often use it without explaining. A short glossary helps:

• Stoma — the opening itself; the piece of bowel visible on the skin.
• Conduit — the internal tube of bowel that carries urine from the ureters to the stoma.
• Ureter — the tube that carries urine from a kidney to the bladder, or after surgery to the conduit.
• Ureteric anastomosis — the join between a ureter and the conduit; a common site for narrowing later on.
• Pouching system, appliance or bag — the pouch and adhesive barrier worn over the stoma.
• Radical cystectomy — surgical removal of the whole bladder, usually with surrounding lymph nodes.
• Cystoprostatectomy — removal of the bladder together with the prostate in men.

What does a urostomy look like?

A urostomy stoma is a small section of small intestine — usually 2–3 cm across — brought to the skin surface. It looks similar to the inside of your cheek: pink to red, moist, and well supplied with blood. It has no nerve endings, so it is not painful to touch or clean. A few spots of bleeding when it is rubbed are common and not alarming, because the surface is rich in tiny blood vessels.

The stoma is usually placed on the right side of the abdomen, because that is the side the ureters and the segment of ileum most naturally reach. It can be placed on the left if your anatomy or previous surgery makes that the better choice.

Why the stoma is positioned before surgery

For all stomas, but especially a urostomy, the site is ideally marked by a stoma care nurse before the operation. You will be asked to sit, stand, lie down, and bend forward while the nurse looks for a flat area of skin that:

• you can see easily when looking down
• is away from skin creases, folds, scars, and the navel
• sits clear of the belt line and the bony prominence of the pelvis
• is on intact, healthy skin

This short exercise has a disproportionate effect on long-term success. A stoma placed in a crease or over a scar is much harder to pouch, and revision surgery to move it is a bigger operation than most people expect.

Why urostomy stomas protrude

Conduit stomas are usually built to sit slightly proud of the skin — typically protruding about a centimetre. This is deliberate. Urine should drip or spurt cleanly into the pouch rather than running back across the skin, where it would lift the adhesive and cause soreness. If a stoma later flattens or retracts, the pouching system often needs to change to a convex design, which gently presses the skin around the stoma upwards.

Why might someone need a urostomy?

A urostomy is created when the bladder either has to be removed or can no longer be used safely. The main reasons include:

• Bladder cancer, particularly muscle-invasive disease requiring removal of the entire bladder (radical cystectomy) — the most common single reason for an ileal conduit
• Neurogenic bladder — a bladder that no longer stores or empties properly because of spinal cord injury, multiple sclerosis, spina bifida, or another neurological condition
• Congenital bladder abnormalities in children, such as bladder exstrophy
• Severe pelvic radiation damage, which can leave a bladder shrunken, painful, or bleeding
• Severe interstitial cystitis that has not responded to other treatments
• Pelvic trauma
• Some gynaecological cancers (cervical or uterine) when treatment involves removing the bladder
• Chronic, severe incontinence that has failed every other approach

Bladder cancer and radical cystectomy

When bladder cancer has grown into the muscle wall of the bladder, removing the whole bladder is usually the most reliable way to control the disease. Because the bladder shares its blood supply and lymphatic drainage with nearby organs, the surgeon typically removes the prostate and seminal vesicles in men, and may remove the uterus, ovaries, and part of the vagina in women. The lymph nodes in the pelvis are usually removed at the same time.

This is why urostomy surgery is longer and more involved than a colostomy or ileostomy. It is not simply the creation of a stoma — it is a major cancer operation with a stoma as its final step.

Non-cancer reasons for a urostomy

For people with a neurogenic bladder, the reasoning is different. The bladder itself may be harmless but unsafe: it holds urine at high pressure, which backflows towards the kidneys and slowly damages them, or it cannot be emptied without repeated catheterisation. A urostomy protects the kidneys by providing a low-pressure, continuous route out of the body.

Urostomy in children

Children are occasionally born with, or develop, conditions that require urinary diversion. Bladder exstrophy, severe spina bifida, and some tumours are the usual reasons. Paediatric urology teams consider the child’s growth, schooling, and long-term independence carefully, and families are usually supported by both a paediatric stoma nurse and the wider children’s ostomy community.

How does an ileal conduit work?

In an ileal conduit:

1. A short section of small intestine (typically 15–20 cm of ileum) is isolated from the rest of the bowel, keeping its blood supply intact
2. The cut ends of the remaining bowel are reconnected, so digestion continues normally
3. The two ureters are stitched into one end of the isolated segment
4. The other end is brought through the abdominal wall and stitched to the skin as the stoma

The isolated bowel no longer absorbs or digests anything. It acts as a passive, muscular pipe — it still performs the gentle wave-like contractions that move urine along, but it does not store urine to any meaningful degree. That is why the pouch must be worn continuously: there is no reservoir and no valve.

What happens to the bowel that is used

Removing 15–20 cm of ileum rarely causes problems, because the small intestine is several metres long and adapts well. Most people notice no long-term digestive change at all. Some find that the first few weeks bring looser stools, which usually settle as the bowel adjusts. If a longer segment of bowel is used — as happens with continent diversions rather than a conduit — absorption of vitamins, bile salts, and water can be affected, and follow-up is more intensive.

Why mucus appears in the pouch

The piece of bowel used to make the conduit continues to produce mucus, exactly as it did when it was part of the digestive tract. This is normal and lifelong. In the early weeks after surgery the mucus is obvious — stringy, white or pale threads in the pouch — and it can occasionally block the outlet. Over months it usually becomes far less noticeable. Drinking well keeps it thin. A mucus plug that will not pass should be discussed with your stoma care nurse rather than forced.

How is urostomy surgery performed?

Urostomy surgery is carried out under general anaesthetic and, when the bladder is removed at the same time, usually takes 4 to 8 hours. A conduit created without removing the bladder — for example in some cases of neurogenic bladder or as a palliative procedure — is a shorter operation.

Before the operation

Preparation usually includes blood tests, imaging of the kidneys and ureters, and sometimes a scan of the bowel if it will be used. Many centres also discuss:

• Prehabilitation — gentle exercise, stopping smoking, and improving nutrition before surgery, which reduces complications
• Stoma marking by the stoma care nurse
• A conversation about diversion options, if more than one is suitable
• Sexual function and fertility, discussed before rather than after surgery

Open, laparoscopic and robotic approaches

The operation can be performed:

• Open, through one larger lower-abdominal incision
• Laparoscopically, through several small incisions using a camera
• Robotically, using a surgical robot controlled by the surgeon — now the most common approach in many specialist centres

All three produce the same stoma; they differ mainly in recovery time, blood loss, and post-operative discomfort. Robotic and laparoscopic approaches generally mean less pain, a shorter hospital stay, and a faster return to normal activity, but not every patient or every hospital can offer them, and open surgery remains entirely appropriate in many situations.

Hospital stay and the first days

A typical hospital stay is 5 to 10 days. In the first days you will have:

• A pouch over the stoma from the moment you wake, usually clear so nurses can watch the stoma and the urine
• Drips, drains, and often a catheter from the urethra, removed once the new diversion is working
• A period of nil-by-mouth, then a gradual return to fluids and food as the bowel wakes up
• Teaching from the stoma care nurse — how to empty, how to change the pouch, and how to manage at night

The first pouch change you do yourself usually happens with a nurse beside you, and most people are independent by the time they go home. It is normal to feel you will never get the hang of it. Almost everyone does, usually within a few weeks.

What does urostomy output look like?

The output of a urostomy is urine. In the first days and weeks after surgery you will also see mucus — a normal, lifelong feature of an ileal conduit, because the bowel used to make it continues to produce mucus even though it no longer digests food.

Urine should be clear to pale straw-coloured when hydration is good. Darker, concentrated urine usually means you need to drink more. Cloudy, foul-smelling, or persistently blood-tinged urine should be discussed with a stoma care nurse or doctor rather than simply monitored.

Normal urine and what changes it

A change in urine appearance is not always a warning sign. The following are usually harmless and temporary:

• Beetroot, blackberries, and some food colourings can tint urine pink or red
• Asparagus gives a distinctive smell within an hour of eating
• B-vitamin supplements turn urine bright yellow
• Some medicines, including certain antibiotics and laxatives, alter colour or odour
• Concentration alone darkens urine — a day of poor drinking will do it

What matters is the pattern: a change that persists, or that comes with fever, pain, or feeling unwell, needs assessment.

Living with a urostomy: the daily routine

Emptying the pouch

A urostomy pouch has a tap or valve at the bottom, opened over the toilet and closed again afterwards. Most people empty when the pouch is about one-third to one-half full — typically every 2 to 4 hours during the day, roughly as often as you would normally have passed urine. Emptying before the pouch is full keeps the weight down, protects the adhesive, and reduces the risk of the outlet becoming messy.

Night drainage

Because urine drains continuously, most people connect their pouch to a larger night drainage bag at bedtime. This is a separate, higher-capacity bag — usually one to two litres — that stands on the floor or hangs on a stand beside the bed and collects urine overnight so you can sleep through without getting up.

A few practical points:

• The night bag connects to the pouch outlet with a simple tubing connector
• It should sit below the level of the stoma, so urine flows downhill
• It is disconnected and emptied in the morning, rinsed with cool water, and replaced at the interval your team recommends
• Some people prefer a single larger pouch overnight instead; your stoma care nurse can advise

Night drainage is one of the most important quality-of-life measures after a urostomy, because uninterrupted sleep is what makes the rest of the day manageable.

Changing the pouch and skin care

The pouching system — or just the pouch, in a two-piece setup — is changed on a regular schedule, typically every 2 to 4 days, or sooner if the seal fails early. The routine is consistent:

1. Remove the old pouching system gently, using an adhesive remover if needed
2. Clean the skin around the stoma with warm water, then dry thoroughly
3. Check the skin for redness, broken areas, or crystals
4. Apply a fresh barrier and pouch, smoothing the adhesive down to make a good seal

The whole change takes 5–10 minutes once a routine is established. Many people change it in the shower, before breakfast, or at a fixed time of day so that it becomes automatic rather than a decision.

Hydration

Good hydration is the single most important self-care habit after a urostomy. Many clinicians suggest aiming for around two litres of fluid a day under normal conditions, but the right target for you depends on your heart, your kidneys, and any other conditions — ask your team what fits your situation.

Good hydration:

• keeps urine dilute, which reduces irritation, mucus build-up, and infection risk
• helps the conduit flush itself
• protects kidney function over the long term

Most drinks count — water, tea, coffee, squash, milk, and juice. Cranberry juice has long been suggested for urinary health; the evidence that it prevents infection is mixed, and any fluid that helps you drink enough is doing most of the work. Very large intakes are not better, and in some heart or kidney conditions a high fluid intake can be harmful, which is why the target is a clinical decision rather than a fixed rule.

Diet

There are usually no major dietary restrictions after the initial recovery. Some foods change urine smell or colour — asparagus, beetroot, and strong B-vitamin supplements — and this is harmless. Alcohol is generally fine in moderation, though it can dehydrate you, so extra water alongside is sensible. Most people return to a near-normal diet within 6–8 weeks.

Clothing

Urostomy pouches are flat and slim, and are invisible under most clothing. Many people prefer high-waisted underwear or a discreet support belt for extra security, especially during exercise. Trousers with a soft waistband are more comfortable than a tight belt worn directly across the stoma.

Showering and swimming

Urostomy pouches are fully waterproof. Showering, bathing, and swimming are all safe. Some people prefer to shower with the pouch off, straight after a change, which is a good moment to let the skin breathe; water will not enter the stoma. If you swim, empty the pouch beforehand and consider a support belt or a smaller pouch for the session.

Sex and intimacy

A urostomy does not prevent a normal sex life, although confidence often takes time to rebuild. Emptying the pouch beforehand, choosing a pouch with a soft fabric cover, and trying different positions can all help. Specialist support — through stoma care nurses, ostomy associations, and sexual-health specialists — is widely available and effective, and there is no need to feel embarrassed about raising it.

For people who have had a radical cystectomy:

• In men, the prostate and seminal vesicles are usually removed as well. This causes erectile changes and dry orgasm, with no ejaculate. Options include medication, vacuum devices, injections, and implants, and they work best when discussed early.
• In women, part of the front wall of the vagina may be removed depending on the cancer. Reconstruction is often possible, and vaginal dryness, narrowing, and discomfort can be managed with lubricants, moisturisers, and pelvic physiotherapy.

A frank conversation before surgery with the urology team is expected and welcomed.

Travel and work

People with urostomies travel widely and work in every profession. Practical points:

• Carry double the usual supplies in hand luggage, plus a small emergency kit in your day bag
• Carry an ostomy travel certificate for airport security; most national ostomy associations publish a template
• Drink more than usual in hot or high-altitude destinations
• Identify a pharmacy near your destination as a backup
• For physical work, build up gradually over the first three months to reduce hernia risk, and agree any heavy lifting with your team

What complications should I be aware of?

Most urostomies do well long-term, but several issues can arise and are worth recognising early. Almost all are easier to manage when caught soon.

Stoma and skin issues

• Skin irritation around the stoma — usually a sign that urine is reaching the skin. A better-fitting pouching system, often with a convex barrier, nearly always solves it. Persistent irritation should be shown to a stoma care nurse rather than treated by repeated product changes.
• Encrustation — small white or greyish crystals, often calcium-based, forming on the stoma or around the pouch outlet. These are more common with concentrated or alkaline urine. Your team may discuss measures such as increasing fluids and specific skin routines used under clinical guidance; do not improvise acidic solutions on your own skin.
• Stoma changes — prolapse, retraction, stenosis (narrowing), and parastomal hernia can all occur, as with other types of stoma. Each has its own management.

Urinary tract infections

Infections are somewhat more common than in the general population, but most people have very few. Because the conduit has no valve, bacteria can travel up towards the kidneys more easily than in a normal urinary tract. Drinking enough fluid is the single best preventive measure. Symptoms can be subtle — cloudy or foul-smelling urine, more mucus, a low-grade fever, or flank discomfort — and should be reported rather than treated with leftover antibiotics.

Kidney issues

Protecting the kidneys is the long-term priority after a urostomy. Some people develop:

• Hydronephrosis — swelling of a kidney caused by backflow or narrowing where the ureter joins the conduit
• Reduced kidney function over years, particularly with repeated infections or chronic dehydration
• Ureteric stricture — a scar narrowing at the join, which may need stretching or revising

An annual review with blood tests (creatinine and eGFR), blood pressure, and periodic ultrasound is standard in most services. Attending these even when you feel well is what keeps small problems small.

Metabolic changes

Because a short section of bowel is in continuous contact with urine, a small number of people develop a mild metabolic acidosis — a slight shift in the body’s acid-base balance. With a normal-length conduit this is rarely a clinical problem, but it is one reason annual blood tests are worthwhile, and it is more likely if kidney function is reduced.

Stones

Urinary stones are somewhat more common after urostomy surgery. Warning signs include sudden severe back or side pain, visible blood, fevers, or a fall in urine output. These should be assessed promptly rather than watched at home.

When to seek medical help

Contact your stoma care nurse, GP, or urology team if you notice:

• The stoma changes colour to dark purple, brown, or black
• No urine output for several hours despite normal drinking
• Fever, chills, or back pain, which may indicate kidney infection
• Persistent or heavy blood in the urine — a few spots after cleaning are common, ongoing bleeding is not
• Cloudy, foul-smelling urine together with feeling unwell
• Severe pain or swelling around the stoma
• A new bulge near the stoma that does not reduce when you lie flat
• Persistent skin breakdown despite your usual pouching routine
• Reduced urine output with swelling of the ankles, face, or hands

If you become unwell and cannot reach your usual team, seek urgent medical advice rather than waiting.

Other types of urinary diversion

While the ileal conduit is the most common urostomy, two other options exist for selected patients.

Continent cutaneous reservoir (for example an Indiana pouch)

A reservoir is built inside the abdomen from a longer section of bowel and connected to the skin through a one-way valve. The reservoir is emptied by inserting a thin catheter through the stoma several times a day. There is no continuous drainage and no pouch is worn. It suits motivated people with good manual dexterity and reliable access to follow-up, because a reservoir that is not emptied on schedule can leak or become infected.

Orthotopic neobladder

A new bladder is built from bowel and connected directly to the urethra, so urine leaves the body in the usual place. The sensation of fullness and the act of voiding are different: many people empty by relaxing the pelvic floor and using gentle abdominal pressure, and some need to catheterise occasionally to make sure the neobladder empties completely. Daytime continence is generally good; night-time leakage is common in the first 6–12 months and may persist. Not everyone is a candidate — the urethra must be free of cancer and the person well enough for a longer operation.

How the choice is made

The decision between a conduit, a continent reservoir, and a neobladder depends on the disease, general health, kidney function, body shape, previous surgery or radiotherapy, manual dexterity, and personal preference. It should be made after a careful conversation with a urology team experienced in all three approaches, and it is entirely reasonable to ask for a second opinion or to speak to someone who lives with each option.

Support and community

Support is widely available and usually free:

• Stoma care nurses at your hospital or in the community — your most useful long-term resource
• National ostomy associations — helplines, peer-visitor programmes, and local meet-ups
• Bladder cancer patient organisations, if your urostomy was made for bladder cancer
• Online peer communities for day-to-day questions and shared experience
• Specialist counselling through hospital teams or community mental health services, if the emotional adjustment is harder than expected

Talking to someone who has lived well with a urostomy for years is one of the most useful things anyone facing the operation can do. It is worth asking your stoma care nurse whether a peer visitor can see you before surgery.

The bottom line

A urostomy is a permanent surgical opening that diverts urine through the abdominal wall, most commonly using a short section of small intestine as a passive pipe — the ileal conduit. It is one of the most important surgical advances of the twentieth century, and for the great majority of people life with a well-fitting pouch is full, active, and confident.

The two practical priorities are good pouching — a well-fitting system, reviewed with a stoma care nurse whenever something changes — and good hydration, within whatever target your team sets for you. With those in place, almost everything else is ordinary life. Always discuss your own care, fluid targets, and any new symptoms with your stoma care nurse or clinician rather than relying on general guidance.