Paediatric Ostomies.

The Urinary Tract and its Function

The urinary tract comprises the kidneys, ureters, the urinary bladder and the urethra. The kidneys filter the circulating blood to remove unwanted materials. The two kidneys filter about 120 to 150 liters of blood every day and produce up to 2 liters of urine per day.

The ureters are thin tubes coming out of each kidney and carry the urine to the urinary bladder. Urine is stored in the bladder until it is full and the brain receives a signal to void. In the case of a neurogenic bladder there is no signal therefore the bladder has to be emptied in other ways.

The bladder has a capacity of about 400 mls. The bladder essentially has two important functions:

  • It stores urine.
  • It empties the urine when it is full.
Urine is voided from the bladder through a tube called urethra, located at the bottom of the bladder. 

What are the reasons for a Urinary Diversion?

A Urinary Diversion is required when the bladder is compromised due to cancer, spinal cord injury (leading to a neurogenic type of bladder) or if it is irreparably damaged due to trauma.

In this procedure an artificial urinary diversion is created to divert the urine either to an external pouch or internally into the intestine.

Different types of Ostomy (urinary diversion)

Ileal conduit Urinary Diversion (Bricker's Loop Urostomy).

This is the most comon type of urinary diversion

An ileal conduit urinary diversion is one of various surgical techniques for urinary diversion. It has sometimes been referred to as the Bricker ileal conduit after its inventor, Dr Eugene M. Bricker. It is an incontinent urostomy, and was first used in about 1911 but only generally accepted about 1950 when Dr Bricker proved how practical it was. Today it is still one of the most used techniques for the diversion of urine after a patient has had their bladder removed, due to its low complication rate and high patient satisfaction level. It is usually used in conjunction with radical cystectomy in order to control invasive bladder cancer.

To create an ileal conduit, the ureters are surgically resected from the bladder and a ureteroenteric anastomosis is made in order to drain the urine into a detached section of ileum at the distal small intestine, though the distal most 25 cm of terminal ileum are avoided as this is where bile salts are reabsorbed. The end of the ileum is then brought out through an opening (a stoma) in the abdominal wall. The residual small bowel is reanastamosed with the residual terminal ileum, usually seated inferior relative to the anastomosis.

The urine is collected through a bag that attaches on the outside of the body over the stoma. The bag is changed as often as necessary. The risk of infection is actually quite small, but there is a high risk of stomal breakdown if not cared for correctly.

Another and very effective use of an ileal conduit is for systemic isolation of a kidney transplant, often due to bladder nephropathy that may pose an unacceptable risk of reflux and thus infection or obstruction, into the transplanted organ. The urostomy is fashioned as previously described and connected by ureteroenteric anastomosis to the transplant ureter. Urinary tract infections are unfortunately very common because stomas are natural colonisers of bacteria; in transplant patients, antibiotic treatment, often over a long term and more frequent appliance changes are effective but not curative countermeasures.

The bag adheres to the skin using a disk made of flexible, adherent materials. Unfortunately, there can be problems with leaking and rashes (excoriation), and heavy physical exertion will exacerbate deterioration of the appliance. Sometimes the leakage occurs unexpectedly, and "ostomates" (as they are known) usually carry a spare appliance to deal with unexpected emergencies.

My name is Lukas, I am one of the administrators of this site, it was an idea of a friend of mine and I. We are both 14 years old and have Ileal conduit urostomies. Josh was born with Sacral-Agenesis/Caudal-Regression and I was born with Amelia of the lower extremities, (I was born without legs).