Ileal conduit (urostomy)
A urine-draining stoma made from a short piece of bowel, usually after bladder removal for cancer. The ED problems: no urine from the stoma means obstruction, and infection means pyelonephritis, not a bladder UTI.
Also called: ileal conduit, urostomy, urinary stoma, urinary diversion, Bricker conduit, urine stoma
What it is
An ileal conduit is a urinary diversion: The procedure involves creating a channel for urine to reach the skin, through a short piece of small intestine (called a conduit)
, with the ureters joined to one end and the other end brought out as a spout stoma (urostomy) draining urine into a bag. It is most often created after the bladder is removed for cancer. A fresh conduit usually has two thin ureteric stents emerging through it, removed 1 to 3 weeks after the procedure
.
For the ED, the key difference from a bowel stoma is that this drains urine from the upper tracts. So the dangerous problems are upper-tract ones: if the conduit stops draining, urine backs up to the kidneys (obstruction, acute kidney injury); and infection is effectively pyelonephritis / urosepsis, not a simple bladder infection, because there is no bladder. Recurrent urinary infection and declining kidney function are recognised long-term risks. This is an adult device in the main (bladder-cancer surgery).
How to recognise it
- A spout stoma on the abdomen draining urine into a bag (usually right-sided) - urine, not stool, is the giveaway that this is a urostomy and not a bowel stoma.
- A patient who has had their bladder removed (often for cancer), or a long-standing urinary diversion for a benign cause.
- In a recently formed conduit, one or two fine ureteric stents protruding through the stoma; these are removed a few weeks post-op.
What it gets confused with
A urostomy drains urine; an ileostomy or colostomy drains bowel content. They can look alike (both spouted stomas with a bag), so check what is in the bag. The emergencies differ: a bowel stoma that stops may be bowel obstruction, whereas a urostomy that stops means the kidneys are obstructing.
What goes wrong
No urine from the stoma (obstruction / AKI)
Little or no urine draining from the urostomy, with flank pain, rising creatinine, or systemic upset - the conduit or the ureters have obstructed.
Red flag
Anuria from a urostomy is obstruction until proven otherwise. BAUS lists Late problems caused by conduit narrowing which may block the drainage of urine
. Exclude a simple blocked/kinked appliance first, then image (the upper tracts) and involve urology urgently - obstruction plus infection is urosepsis.
Infection - pyelonephritis / urosepsis, not a bladder UTI
Fever, flank pain and feeling unwell in a conduit patient. BAUS lists Recurrent urinary infections
as a common outcome.
Red flag
There is no bladder - infection is upper-tract (kidney) infection and can become urosepsis, especially if the conduit is draining poorly. Treat sepsis and involve urology; a cloudy bag with mucus alone (conduits always produce mucus) is not infection.
Stoma ischaemia, retraction or parastomal problems
A dusky or black urostomy, a stoma that has retracted or prolapsed, a parastomal hernia, or peristomal skin breakdown and leakage.
Red flag
A dusky/black urostomy is ischaemia - a surgical emergency, as for any stoma. Parastomal and skin problems need the stoma nurse and urology; an obstructed parastomal hernia needs urgent surgery.
Metabolic and renal decline
A chronically unwell conduit patient with a metabolic (hyperchloraemic) acidosis, electrolyte disturbance or declining renal function - recognised consequences of urine sitting against bowel mucosa.
Red flag
BAUS lists Decreased kidney function with time
among the common long-term effects. Check U&E and a venous gas, correct acidosis, and consider whether poor drainage is contributing.
The first ten minutes
- Check the stoma is draining urine. No urine from the urostomy means obstruction - of the appliance, the conduit or the ureters - until proven otherwise.
- Exclude a simple appliance problem first (kinked bag, blocked night bag), then think conduit/ureteric obstruction and image the upper tracts.
- Treat infection as pyelonephritis / urosepsis, not a bladder UTI - there is no bladder - and remember a conduit normally produces mucus, so cloudy output is not proof of infection.
- For a dusky or black stoma, call surgery now - ischaemia is an emergency.
- Check U&E and a venous gas for obstruction, acute kidney injury and metabolic acidosis.
- Involve urology and the stoma care nurse for obstruction, infection, or stoma viability and appliance problems.
Do not
Who owns it
Urology owns the conduit and the upper tracts; the stoma care nurse owns the appliance and skin. Tell them whether urine is draining, whether the patient is septic, the U&E and acid-base, and the stoma's colour and viability.
Who to call
The team and the criteria are national. The phone number is local, and this tool does not know it. Find it once, now, and write it on the department's own card — that is the part no website can do for you.
- Say the device name first
- Open with laryngectomy, LVAD, shunt — the single word changes who comes and what they bring. Do not bury it in the history.
- Say what you have already established
- Whether the device is patent, whether it has been removed or disturbed, and what you have already tried. The specialist is deciding whether to walk or run.
- Ask who owns it out of hours
- Device ownership and the on-call route often differ from the implanting specialty, and it is frequently a regional centre rather than your own hospital.
- The patient's own team is a resource, not an afterthought
- Named nurse specialists, home-care companies and device helplines answer questions nobody else can, and the patient usually has the number.
When the device is not the problem
A patient with a device gets pneumonia, sepsis, pulmonary oedema and myocardial infarction at the same rate as everybody else. The device is the most visible thing about them and it attracts the whole assessment.
- The NTSP says it out loud
- The project's own manual warns that
patients with tracheostomies can become unwell with all the problems that other patients get too. It is easy to become fixated with the tracheostomy.
The same sentence applies to every device in this tool. - Clear the device, then leave it
- Establish that the device is doing its job — the stoma is patent, the line draws back, the pump is running — and then assess the patient as you would anyone else.
- The anchoring runs both ways
- The opposite error is treating a device complication as a medical illness: a blocked gastrostomy read as vomiting, a baclofen pump failure read as sepsis.
- NTSP manual — Red flags · read in full
What the patient will be carrying
Urostomy patients and carers are usually expert in their appliance and know their urology and stoma-nurse contacts; they can tell you their normal output and what has changed.
Scope of this page
This page covers the ED response to an ileal conduit / urostomy: obstruction (no urine), upper-tract infection/urosepsis, stoma viability, and metabolic/renal decline. It does not teach conduit formation or revision, or routine appliance care (a urology and stoma-nurse matter). An ileal conduit is predominantly an adult device; a paediatric urinary diversion is directed by paediatric urology.