Ureterostomy Unilateral

Ureterostomy unilateral surgery

A unilateral ureterostomy is surgery in which one ureter of the abdomen is brought to the surface of the abdomen, and a stoma is formed, through which urine of one kidney might drain into a urostomy bag. It is normally done when the normal urinary passageway (ureter to bladder to urethra) is blocked, damaged or even has to be diverted.

What Is a Unilateral Ureterostomy?

• The stoma (opening) is made on the one side of the abdomen.
• The skin is connected to one of the ureters.
• The urine empties continuously in a urostomy bag.
• As a rule, performed when there is a single affected kidney/ureter.

Signs of Unilateral Ureterostomy

The doctors could suggest the procedure in cases that include:

Obstruction of the Ureter

• Kidney stones
• Ureteric stricture
• Congenital obstruction

Tumors

• Bladder cancer
• Ureteral cancer
• Obstructed ureter by tumor in the pelvis.

Injury or Trauma

• Surgical problems in the pelvis.
• Injury of the ureter in C-section or hysterectomy.

Severe Infection

• Diversion due to pyonephrosis or frequent infections.

Rebuild not possible

• In the case where the bladder repair or reimplantation of the ureters cannot be done.

Unilateral ureterostomy procedure India

A unilateral ureterostomy is a surgical diversion surgery in which one of the ureters is diverted to the abdomen surface as a urostomy bag to enable it to drain the urine. It is performed in case of the obstruction or rupture of the normal urinary passage.

Preoperative Preparation

Assessments

• Blood tests, urine tests
• Function tests of the kidney (serum creatinine, urea)
• Ultrasound / CT scan
• Cystoscopy or retrograde pyelogram (as necessary).

Preparation

• Fasting for 6–8 hours
• Marking of stoma, stoma nurse or surgeon.
• Prophylactic antibiotics

Anaesthesia

• The surgery is carried out under general anaesthesia.
• Patient does not regain awareness and is in pain-free condition.

Surgical Steps

Step 1: Incision

• A small cut is made on lower abdomen normally on right or left side based on affected kidney.

Step 2: Identify the Ureter

• The surgeon identifies the involved ureter (either the right or the left ureter).
• Ureter is pulled with a lot of care and detached by the tissues.

Step 3: Incision and Ureteral Preparation

• The latter end of the ureter (bladder side) is excised or bypassed.
• The higher (kidney end) is left to drain.

Step 4: Catheter to Skin Surface

• On abdomen a small opening (stoma) is made.
• This opening is pulled through and a ureter is pulled through.

Step 5: Create the Stoma

• The ureter end is slightly evverted (eversion).
• It is sewn to the edges of the skin in order to create a stable stoma.

To temporarily place in the ureter a small stent that will:

• Maintain patency
• Reduce risk of blockage
• Prevent retraction

Step 6: Apply the Urostomy Bag

• A drainage pouch is attached.
• Splashes around the stoma are covered with the special adhesive barriers.

Duration of Surgery

• Typically 1-2 hours, with the condition of the patient.

Factors Affecting Ureterostomy unilateral surgery cost

Some of the critical influencing factors in cost, especially in India, are given below:

Health and Complexity of Case of the patient

• The presence of comorbidities (e.g., diabetes, hypertension, obesity) will be a risk factor and require more monitoring/ICU. 
• Beginning disease extent: as an example, in case of a ureterostomy in cancer, a large surgery can be necessary (as compared to a less complex diversion).
• Complexity (complications are present or not) (infection, previous surgery, scar tissue) - more complicated = more expensive.

Hospital Type & Location

• In Metro cities (New Delhi, Mumbai, Bengaluru) the charges are higher because of the cost of infrastructure, specialized experts, overheads. 
• Small hospitals are cheaper than the private super-specialty hospitals. 
• The cost of staying in the hospital depends on the type of room that the patient has selected (single deluxe vs shared ward). 

Fees and Technology of Surgeon / Specialist

• Older or highly reputed urologists or centers can be more expensive. 
• Higher costs are incurred through the use of high equipment or minimally invasive procedures (when suitable).

Staying Time in Hospital and Recovery Time

• Delayed recovery, complications cannot be avoided because of longer hospitalization = more expensive. 
• The costs will increase drastically in the case of intensive care stay.

Consumables, Pre-operative & Post-operative Investigations

• There are tests (blood, imaging, renal functioning) to be added.
• Consumables: urostomy bags, urostomy tubes, urostomy bags, stents, extra equipment.
• Post-op treatment: stoma care education, follow-ups, dressings.

Other Procedures / Complications

• In case there is a requirement of extra work during the surgery (e.g., a reconstruction work, addressing related complications) the price will be higher.
• The overall cost is increased by the complications (infection, bleed, reoperation) management.

Oversights in international Patient / Medical Tourism

• In the case of international patients: travel, accommodation, translator, long stay due to follow-ups.
• Other hospitals have international patient services that might incur additional administrative expenses.

Best hospital for ureterostomy unilateral India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Ureterostomy unilateral post-operative care

Following a unilateral ureterostomy, it is important to provide adequate care to avoid complications, preserve renal activity, and have the stoma functioning effectively.

Acute Right after Surgical Intervention (Hospital Phase)

• Duration: The duration varies and is usually between 2 and 4 days as per recovery.

Monitoring

• Urine output: Urethra is functioning well.
• Vital signs: Blood pressure, pulse, temperature.
• Stoma condition: Look at bleeding, swelling or leakage.
• Kidney work: Blood tests (creatinine, urea) on demand.

Medications

• Pain management (analgesics)
• Antibiotics in order to prevent infection.
• Stool softeners (to prevent straining in case bowel is affected)

Stoma Care Training

• The nursing personnel educate the cleaning and care of the stoma.
• How to drain and change urostomy bags.

Early Home Care (First 2–3 Weeks)

Stoma Management

• Wash the stoma daily with a mild soap and water.
• Pat dry gently; do not rub.
• Make sure that the urostomy bag is snug in order to avoid leaks.
• Rechange the bag after 3-5 days or earlier in case of leakages.
• Do not use adhesives over broken or inflamed skin.

Fluid Intake

• Take in 2-3 liters of water in a day, unless your physician restricts water.
• This will aid in avoiding infection and in maintaining urine flow.

Wound Care

• Hold surgical incision dry.
• Observes redness, discharge or swelling.

Activity

• Heavy lifting or vigorous activity is to be avoided during at least 4–6 weeks.
• It is recommended that one walks gently to avoid blood clots and enhance recovery.

Diet Recommendations

• Eat a nutritious diet to aid in recovery.

Include:

• Low-fat dairy products (milk, yogurt, cream of tartar, ricotta, cheese, milk)
• Vegetables (except limited to fresh ones) and fruits Fresh fruits and vegetables (except limited to fresh ones)
• Whole grains
• It is advisable to avoid food that can irritate the bladder or kidneys (excess salt, caffeine).
• Keep hydrated so that urine can be diluted and infection can be prevented.

Long-Term Stoma Care

• Observing stoma color, swelling, or infection.
• Cover the skin surrounding the stoma using barrier creams or wiping.
• Always empty the bag when it is not past 2/3 full.
• Pack additional stoma supplies when travelling.

Ureterostomy unilateral complications

Unilateral ureterostomy is not a dangerous procedure, however, as with any other operation, there are risks. The stoma, skin, ureter, or kidney functioning may have complications.

Early (Post-Operative) Complications

These normally take place during the initial days/weeks following operation.

Bleeding (Hemorrhage)

• Effects: Damage to small blood vessels occurred in the course of surgery.
• Symptoms: No blood in the urine or around the stoma, edema, hemorrhage.
• Treatment: It is self-limiting in most cases; in the case of severe bleeding, treatment may be necessary.

Infection

• Etiology: Surgery contamination or bad stoma care.
• Symptoms: Fever, erythema, pus in the stoma, urine that is foul.
• Treatment: Antibiotics; rigid stoma hygiene.

Urine Leakage

• Cause: inadequate sealing of ureter to the skin, ureter tension, or wound breakdowns.
• Symptoms: Wet dressing, skin irritation or urine pooling.
• Treatment: In severe cases stoma revision can be necessary.

Stoma Edema (Swelling)

• Reason: Trauma of tissues, insufficient blood circulation or infection.
• Symptoms: Stoma edema, pain.
• Management: Cures itself; observe ischemia.

Late (Long-term) Complications

These can occur weeks to months following the operation.

Stoma Stenosis (Narrowing)

• Etiology: Scarring on the stoma opening.
• Signs: swelling of kidney (hydronephrosis), pain, decreased renal urine flow.
• Treatment: Stoma dilation or surgical revision.

Stoma Retraction

• Etiology: Ineffective surgical skills or overstretching of ureters.
• Symptoms: Stoma subsides below the skin, urine leakage.
• Treatment: Surgery can be required.

Skin Irritation / Dermatitis

• Reason: Urine leakage to the skin or allergy to adhesive.
• Symptoms: Puritus, rash, stoma sores.
• Treatment: Barrier creams, urostomy bags well fitted.

Obstruction of the Ureters / Hydronephrosis

• Etiology: Kinking of ureter, stoma stricture, or the formation of stones.
• Symptoms: Pain in the flank, decreased urine flow, increased renal-function examination.
• Treatment: Visual inspection, perhaps insertion of a stent or surgery.

UTIs 

• Etiology: Bacteria ascending via ureter or bad stoma hygiene.
• Symptoms: Fever, burning, turbid urine.
• Treatment: antibiotics, optimization of hygiene.

Parastomal Hernia

• Etiology: Frail abdominal wall.
• Symptoms: Stomal pouting, pain, discharges.
• Treatment: Surgical repair in case of symptoms.

Further Degeneration of the kidneys

• Etiology: Chronic obstruction, infection or reflux.
• Symptoms: Increased creatinine, pain, frequent infections.
• Treatment: Routine observation and treatment, when necessary.

Rare Complications

• Necrosis of the ureter (loss of blood to ureter)
• Urine fistula (a defective correlation of the skin or other organs)
• Psychological effect as a result of stoma and changes in lifestyle.

Conclusion

Unilateral ureterostomy is a simple and safe operation that can be performed to divert urine of one kidney with the normal urinary tract being blocked, damaged or rendered ineffective. It is normally done when the ureters are obstructed, traumatized, infected, or neoplastic. The procedure is successful because of:

• The correct patient selection and pre-operative assessment.
• Skilled surgical technique
• Sufficient aftercare such as care of stomas, preventing infections and follow-up.

Although complication may include stoma stenosis, urinary tract infection, skin irritation or an obstruction in the ureter, most of them can be prevented or controlled through close care and observation. Through proper management, patients will have good kidney functions, quality life and long-term stoma health.

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FAQ

Is the procedure permanent?

It may be both provisional and fixed:

• Temporary: In case the function of ureter or bladder can be recovered in the future.
• Permanent: To be used when permanent urinary diversion is necessary.

Does postoperative kidney functionality improve?

• Yes, especially when the kidney was clogged. The presence of an appropriate urine drainage system alleviates the pressure on the kidney and avoids damage.

How frequently should the follow-up visits be made?

• The first follow-up: 1-2 weeks after surgery.
• Follow-up visits: Every month or as advised to check on kidney and stoma condition.

Is the ureterostomy reversible?

• Yes, provided that the underlying condition is curable and that the bladder is in sufficient functional condition. In permanent cases, reversal is not always the case.