Topic Explanation
The forum discussion centers around an individual who is facing bladder removal surgery due to a recurrence of bladder cancer. The person is highly active, engaging in activities such as road biking, downhill skiing, running, and hiking, and is seeking advice on whether to opt for a continent (internal pouch) or incontinent (external pouch) urostomy. The goal is to understand the pros and cons of each option to maintain an active lifestyle post-surgery.

Advice and Insights

1. General Advice for Active Lifestyle:
- Core Strength: Increasing core strength before surgery can be beneficial for post-surgery activities.
- Support Systems: Use a good belt/support/hernia protection system for activities like skiing, hiking, running, and cycling.
- Hydration: Staying hydrated is crucial, especially for those with an ileal conduit.

2. Incontinent (External Pouch) Urostomy:
- Adjustment Period: There is an initial adjustment period to get used to the bag and manage complications like fit and sticking.
- Activity Compatibility:
- Activities such as scuba diving, triathlons, pickleball, swimming, and mountain biking are feasible.
- Regularly emptying the bag is important to prevent infections.
- A bedside bag can be used at night to manage urine flow.
- Travel Tips: Always carry extra supplies when traveling, as availability can vary by location.
- Maintenance: Change the appliance every few days and the bag daily to avoid infections.
- Placement of Stoma: Discuss with the surgical team about the optimal placement of the stoma for comfort and convenience during activities.

3. Continent (Internal Pouch) Urostomy:
- Pros:
- No external bag, which can be more discreet.
- Reduced amount of supplies needed.
- Cons:
- Requires a larger section of the intestine, which can affect nutrient absorption.
- Needs regular emptying on a strict schedule, which can disrupt sleep.
- Involves inserting a catheter, which can be challenging over time and increase the risk of ulcers or infections.
- Uric acid can penetrate bowel tissue into the bloodstream over time.

4. Personal Experiences:
- Positive Outcomes: Many individuals report being able to return to an active lifestyle post-surgery, including activities like fishing, camping, and working