The surgeon makes the continent urinary diversion during the operation to remove the bladder. They make a pouch that holds urine from a piece of your bowel. They attach your ureters to the pouch so that urine from your kidneys drains into the pouch.
The surgeon uses another piece of tissue (such as your appendix) to make a tube to connect the pouch to your tummy wall. They make a small opening (stoma) from the tube on to the tummy wall. This type of stoma lies flat against the skin.
You empty urine from the pouch through the stoma by using a tube (catheter). This is called self-catheterisation. You need to do it about 5 or 6 times a day.
After surgery, you will have 2 catheters in place. One goes into the pouch through your tummy and the other goes through the stoma. These stay in place for a few weeks while you recover from the operation.
Once the pouch has healed (usually about 6 weeks after your surgery), you will go back to the hospital. You will usually stay in hospital for 1 or 2 days for the catheters to be removed. You will also learn how to empty the pouch and wash it out. Your specialist nurse will teach you how to do this.
Before you leave the hospital, the nurse will make sure you have a supply of the equipment you need. This can include catheters. When you are at home, you can get your equipment directly from a supplier or your chemist. Your nurse will tell you more about this.
The Urostomy Association can also give you details of suppliers.
When you get home, you will still be able to speak to your specialist nurse for advice. The hospital staff will arrange for a district nurse or a community stoma nurse to visit you when you first leave the hospital. They can help you cope with any problems.
Getting used to a urinary diversion and learning to look after it takes time. Like anything new, it will get easier with time and practice.
Your specialist nurse will give you lots of support before and after your operation. They will show you how to care for and manage the urinary diversion.
Emptying your pouch
To empty your pouch, you put a tube (catheter) through the stoma into the pouch. Your specialist nurse will show you how to do this. At first, you do it every couple of hours until your pouch stretches. Eventually, you may be able to leave the pouch for up to 6 hours without emptying it. You may find it helpful to set an alarm to remind yourself to empty the pouch.
Washing out your pouch
As well as emptying your pouch, you need to wash it out. The bowel tissue used to make the pouch continues to make mucus. This is a thick, white liquid. It might appear as pale threads in the urine. If it is not washed out, it can cause an infection.
You need to wash out your pouch several times a day. To do this, you put fluid through the catheter that you use to drain your pouch. Your specialist nurse will teach you how to do this.
Different surgeons may give slightly different instructions on how you should empty and flush out your pouch, and the equipment you should use. Follow the advice you are given. If you need more support, talk to your specialist nurse or doctor.