Name of the Procedure:

Revision of urinary-cutaneous anastomosis (any type urostomy); with repair of fascial defect and hernia

Summary

This surgical procedure involves correcting issues with a previously created urostomy (an opening made to divert urine away from the bladder). It includes repairing the area where the urine passageway meets the skin, fixing any muscle layer defects (fascial defects), and addressing any hernias (protrusions of organs or tissues through weak muscle areas).

Purpose

The procedure addresses problems related to a urostomy, such as leaks, infections, or discomfort. It aims to improve the function of the urostomy, repair weakened muscle layers, and fix hernias, enhancing the patient's quality of life and reducing complications.

Indications

• Persistent leakage or infection around the urostomy
• Discomfort or pain in the urostomy area
• Visible bulging or hernia near the urostomy site
• Noticeable weakness in the muscle layer supporting the urostomy

Patients experiencing these symptoms or conditions may be candidates for this revision surgery.

Preparation

• Fasting may be required several hours before surgery.
• Medication adjustments might be necessary, particularly blood thinners.
• Preoperative assessments may include blood tests, urine tests, imaging studies, and a physical exam.

Procedure Description

1. The patient is given anesthesia to ensure they are asleep and pain-free.
2. The surgeon makes an incision at the site of the existing urostomy.
3. The urinary-cutaneous anastomosis is carefully revised to fix leaks or other issues.
4. The surgeon repairs any fascial defects, reinforcing the muscle layer.
5. Any hernias are addressed by repositioning the protruding tissue and securing the muscle wall.
6. The incision is closed with sutures or staples, and a dressing is applied.

Tools and equipment include surgical scalpels, sutures, staples, retractors, and specialized instruments for handling hernias and muscles.

Duration

The procedure typically takes between 2 to 4 hours, depending on complexity.

Setting

The surgery is performed in a hospital or a specialized surgical center.

Personnel

• Surgeon specialized in urological or general surgery
• Anesthesiologist
• Surgical nurses
• Possibly a surgical assistant or resident

Risks and Complications

• Infection at the surgical site
• Bleeding
• Recurrence of the hernia
• Injury to surrounding tissues or organs
• Anesthesia-related complications

Benefits

• Improved function and appearance of the urostomy
• Reduced risk of leakage and infection
• Relief from discomfort or pain
• Strengthened muscle support reducing the chance of future hernias

Benefits are generally realized within a few weeks after recovery from surgery.

Recovery

• Patients may need to stay in the hospital for a couple of days.
• Instructions include wound care, activity restrictions, and follow-up appointments.
• Full recovery might take several weeks, during which heavy lifting should be avoided.
• Pain management and monitoring for signs of infection are crucial.

Alternatives

• Non-surgical options such as wearing support garments or using adhesive products for leaking urostomies
• Physical therapy to strengthen abdominal muscles
• Another surgical approach with different techniques

Alternatives may offer varying benefits and risks, often less invasive but sometimes less effective for severe conditions.

Patient Experience

Patients may experience discomfort and swelling after surgery, managed with pain medication. Follow-up care focuses on ensuring proper healing and function of the revised urostomy. Most patients can return to normal activities within a few weeks, adhering to any activity restrictions provided by the healthcare team.