Catheterization and Urostomy for the Community Pharmacist

Lynn Fletcher, PharmD

Disclosures

US Pharmacist. 2013;38(8):27-30. 

In This Article

Urostomy

Urostomy is a rerouting of the ureters that is necessitated by a damaged or diseased urinary system.[1,2] In this procedure, the bladder is removed or bypassed and the ureters are connected to an opening in the abdominal wall.[1,3] Urine is then collected in a pouch worn outside the body.[1,2]

Reasons for Urostomy

There are several conditions that may warrant urostomy. One of these is bladder cancer, in which case the bladder may have to be removed entirely to keep the cancer from spreading.[2,3] A defective bladder arising from a birth defect, spinal injury, or surgery may be another reason for urostomy.[3] Nerve damage, exstrophy, chronic pyelonephritis, and trauma are other specific circumstances that may require urostomy.[1,2] Ultimately, any condition that causes a blockage of urine flow and results in accumulation in the ureters and kidneys may necessitate this procedure.[2,3]

Urostomy Procedures

In one urostomy process, an ileal conduit is constructed from a piece of the ileum in the small intestine.[2,3] This is the standard urostomy procedure.[2] The ureters are detached from the bladder and connected to one end of the ileal conduit.[1,2] A stoma (opening) is formed by bringing the other end of the ileal conduit through the abdominal wall (Figure 1).[2,3] At this point, urine output is no longer controlled, and a pouch is necessary to collect the urine.[1,2] Another available option is the ureterostomy. In this procedure, no ileal conduit is used, and the ureters are directly connected to the abdominal wall to create a stoma. A collecting pouch is still needed.[3]

Figure 1.

Completed urostomy.

Changing a Urostomy Pouch

Patients need to be well educated on how to change their urostomy pouch. Patients receive information before leaving the hospital, but reinforcement in the community setting is often necessary.

First, the patient should wash his or her hands thoroughly before changing the pouch.[1,2] The next step is to clean the stoma and the skin around it with a wet towel or washcloth.[1,3,4] Once the skin is dry, a skin barrier is applied to protect the skin from urine.[3–5] The skin barrier may be precut or may require a hole cut out for the stoma.[2] If a hole needs to be cut, the stoma should be measured using a guide, traced on the back of the skin barrier, and cut accordingly.[4,5] The skin barrier should be no more than one-eighth of an inch larger than the stoma.[2] To apply the skin barrier, the paper backing should be removed and the skin barrier centered over the stoma and firmly held in place for at least 30 seconds.[4,5] If the product is a one-piece urostomy pouch, the bag is attached to the skin barrier; if a two-piece pouch is used, however, the bag must be attached separately.[2] In this case, the bag should be opened to let in a small amount of air and lined up with the skin barrier for attachment.[5]

Urine should be emptied from the pouch prior to removal. To remove a pouching system, the skin barrier should be held taut and pulled downward while the skin is pushed away from the skin barrier.[4,5] It is important to change the pouching system when fluids have been limited for several hours; the best time is the morning.[1,2]

Urostomy Products

Many different urostomy brands and products are available.[2] When a patient is choosing a product, factors that should be taken into consideration are stoma length and location, abdominal firmness and shape, scars and folds near the stoma, and the patient's height and weight.

A good pouch should be flush to the skin to allow easy passage of urine, last 3 to 7 days, and protect the skin around the stoma.[2,6] It also should be easy to attach and remove and should be nearly invisible under clothing. As previously mentioned, there are two main urostomy pouching systems. Both systems include the adhesive skin barrier and a collection pouch. One type is the one-piece pouch, which attaches directly to the skin barrier. In the two-piece system, the pouch can be detached from the skin barrier.[2]

Ostomy belts and tape, while not necessary, are other products that patients may be interested in obtaining. A belt provides support by attaching to the pouching system and wrapping around the waist. Tape is used around the outside edge of the skin barrier for additional comfort. Skin wipes and ostomy powder may be used to further protect the skin around the stoma.[2] Caulking material may be applied to the skin barrier to fill gaps between the skin barrier and the stoma.[5] Finally, night-drainage systems are convenient because the pouch does not have to be emptied during the night.[2]

Counseling for Urostomy

The patient should be counseled to check for signs of possible infection: dark or foul-smelling urine, back pain, poor appetite, nausea, and vomiting. If any of these symptoms are present, the physician should be contacted.[1,3] The collection pouch should be emptied at regular intervals, generally when it is about one-third full.[1,2] The pouch needs to be changed every 5 to 7 days, and more often if leakage occurs.[1] If a night-drainage system is used, the container should be vented with the tubing secure at the top. The pouch should be cleaned every morning.[2] Dietary changes generally are not necessary, unless kidney problems are present.[2,3] Lastly, seams and waistbands should not be placed directly over the stoma.[1]

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