Adult urostomy care

What is a urostomy?

A urostomy is a surgical procedure that redirects urine flow from the body, typically used when the bladder is unable to function properly due to disease or injury. The surgery connects the ureter directly to the abdominal wall, creating an opening called a stoma from which urine flows continuously. The patient wears a special ostomy bag to collect the urine. Common indications include post-radical cystectomy for bladder cancer, neurogenic bladder dysfunction, severe interstitial cystitis, or loss of bladder function due to trauma or congenital malformations. Unlike temporary stomas, urostomies are usually permanent, meaning patients need lifelong learning and adaptation to living with one.

How to choose the right stoma care products?

Choosing the right care products is the cornerstone of effective management. The core components of a urostomy bag are the baseplate and the urine bag itself. The baseplate needs to be precisely cut to fit the shape and size of the stoma, typically 1-2 mm larger than the stoma itself, ensuring a snug fit without compressing the stoma mucosa. Since urine is a continuously flowing fluid, a urine bag with an anti-backflow valve must be chosen to prevent nighttime urine backflow from soaking the baseplate and causing leakage. For cases with high urine output, a high-capacity (usually 800 ml or more) nighttime drainage bag should be considered. Protecting the skin around the stoma is crucial; skin protectants, leak-proof creams, or leak-proof rings can be used to isolate urine irritation. If skin problems occur, such as redness or breakage, special products containing stoma powder or skin protectants may be necessary. It is recommended to find the most suitable product combination for your skin type and lifestyle through trial use under the guidance of an ostomy therapist.

What is the standard procedure for daily care?

Establishing a regular nursing routine can greatly improve your sense of control over your life. The ideal frequency for changing the ostomy bag is every 3 to 5 days, or immediately when the baseplate shows signs of leakage. Before proceeding, prepare all necessary supplies, including a new ostomy bag, mild cleaning wipes, scissors, a measuring ruler, a mirror, and a waste bag. When changing, gently peel the old baseplate from top to bottom, avoiding forceful tearing that could damage the skin. Clean the stoma and surrounding skin with warm water or a dedicated, non-irritating cleaning wipe, patting dry rather than rubbing. Measure the size of the stoma and cut the new baseplate accordingly, applying leak-proof ointment if necessary. Attach the new baseplate from bottom to top, ensuring the stoma is centered in the opening. Press the baseplate firmly with your palm for several minutes, using your body heat to help it fit better. Finally, connect the urine bag and ensure the drainage valve is closed. Maintain patience and care throughout the process.

How to prevent and manage common complications?

The most common complication of urostomy is peristaltic irritant dermatitis, caused by the continuous irritation of the skin by urine. Prevention is key to ensuring a good seal on the stoma and replacing it immediately if leakage is detected. A skin protectant can be used to form a protective layer. If dermatitis has already occurred, after cleaning, stoma powder can be used to absorb moisture, followed by spraying a skin protectant to form a protective layer. Another common problem is uric acid crystallization, which manifests as white or grayish-white powdery crystals around the stoma, potentially irritating the skin and producing an odor. Treatment involves regularly cleaning the area with a diluted white vinegar solution (vinegar to water ratio of 1:3) to dissolve the crystals, and drinking plenty of water to dilute urine. The stoma itself may experience problems such as edema, stenosis, or granulation tissue growth, which require professional evaluation and treatment by a doctor or stoma therapist. Do not attempt to trim or apply medication yourself.

What should we pay attention to regarding diet and water?

Adequate hydration is the first priority in urostomy care. It is recommended to drink approximately 2000 ml of water daily. This dilutes urine, reduces irritation to the stoma mucosa and skin, and lowers the risk of urinary tract infections and uric acid crystal formation. Regarding diet, there are no special dietary restrictions, but it's important to observe the effects of certain foods on urine odor and color. For example, asparagus and fish may intensify urine odor, while beets may turn urine reddish. Understanding these effects can help avoid unnecessary panic. Maintaining a balanced diet and consuming foods rich in vitamin C (such as oranges and kiwis) can acidify urine and inhibit bacterial growth. However, it's important to note that some foods, such as spinach and strawberries, contain high levels of oxalic acid; excessive intake may increase the risk of urinary tract stones, so they should be consumed in moderation.

How to adapt to daily life and social activities?

Living with a urostomy requires some adaptation and practice. Wear loose, soft, and breathable clothing, avoiding direct pressure on the stoma from belts or waistbands. For example, when showering, you can choose to wear the urostomy bag while showering, or remove the bag to rinse directly without water entering the stoma. When engaging in water activities such as swimming, a mini urostomy bag or waterproof cover can be used. Before traveling or going out for extended periods, always check the urostomy bag for a proper seal and prepare sufficient nursing supplies. In social and work settings, choosing an appropriately sized urine bag and emptying it promptly usually does not affect normal activities. Many patients worry about odor, but deodorizers and urostomy bags with carbon filters are available on the market and can effectively control it. Most importantly, build confidence. A urostomy is a life-sustaining medical procedure, and with proper care, you can absolutely lead an active and fulfilling life.

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Editor: kiki Jia