How to urinate?
There are various ways in which you can make sure that your urine leaves the body through the ureters after bladder removal. We will discuss your options with you. Below is a short overview of the various possibilities:
Urostomy (Bricker)
To create a urostomy, your surgeon will use a part of the end of the small intestine through which the urine leaves the body. Because the resulting flow will be continuous, you will need to attach a small bag to collect the urine. You will never have to worry about visiting the bathroom. Once the bag is full you can easily empty it in the toilet. You won't need to set an alarm at night to empty the urostomy. One downside is that this method will change the appearance of your stomach.
Neobladder
Your surgeon will use a section of the end of the small intestine to create a pouch, which will be attached to the urethra. This won't cause any visible changes to your body.
By pressing down on the abdomen and using your abdominal muscles, you can empty the neobladder. Your urine will leave the body through the urethra. One downside is that the urine may not come out as easily, requiring a catheter, or our sphincter may not be strong enough to hold in the urine, which can lead to incontinence. You won't feel the urge to urinate and will have to make sure that you can go to the bathroom at specific times, including at night. You will also be at a higher risk of urinary tract infections than people with a urostomy.
Indiana pouch
Your surgeon will use a part of the end of the small intestine and the start of the large intestine to create a pouch. Unlike a neobladder, this pouch is not connected to the urethra but instead leads to a catheter that leaves the body through the abdominal wall, usually near the belly button.
The pouch will need to be emptied every couple of hours with the help of a catheter. You will not be able to urinate yourself. The pouch rarely leaks, so you won't need a bag to collect the urine and can close it off using a bandaid instead. You may experience problems with the insertion of the catheter, or fully emptying the pouch, which can cause urinary tract infections. After several years, the pouch may start leaking, requiring a patch made out of a bit of your skin. Your abdomen will have a different appearance due to the opening for the catheter and the bandaid.
Colonic conduit
This is a rare approach only used with patients who also need to have part of their rectum removed and who also need a colostomy. We can opt to use a part of the large intestine instead of the small intestine to craft a urostomy. The pros and cons of this are comparable to the Bricker, although patients receiving a colonic conduit won't need to have a connection in the colon made during surgery.
Ureterocutaneostomy
Patients who will only have one kidney left after surgery may need a type of ostomy that leads the ureter directly outside of the skin without a pouch made out of the intestine. The urine will flow directly into the bag attached to the abdomen. The main benefit is that you won't need to undergo intestinal surgery, which will speed up your recovery. You may experience scarring near the opening, which can clog the drain. Patients with a ureterocutaneostomy will need to have a tube running from the kidney to the skin to keep the drain open and accessible. This is called a single J and will need to be replaced regularly at the clinic.
You can find more information in Dutch on www.stomaofneoblaas.nl.
