Urostomy Location
A urostomy stoma is typically located on the anterior abdominal wall, most commonly in the right lower quadrant, positioned lateral to the rectus abdominis muscle and below the belt line. 1
Anatomical Positioning
The optimal stoma site should be marked preoperatively by an enterostomal therapist or specialist urology nurse clinician before radical cystectomy. 1 This preoperative marking is critical for:
- Selecting a site that avoids skin folds, scars, and bony prominences to reduce postoperative complications such as leakage and peristomal dermatitis 1
- Ensuring the patient can visualize and access the stoma for self-care management 1
- Positioning away from the waistline to prevent appliance interference with clothing 2
Specific Location Criteria
The stoma is created through the abdominal wall with these considerations:
- Placement through or lateral to the rectus abdominis muscle provides better fascial support and reduces hernia risk 3
- Location should be visible to the patient when standing and sitting to facilitate pouching system changes 2
- Distance from bony prominences (iliac crest, costal margin) of at least 5 cm to allow proper appliance seal 2
Clinical Context
A urostomy is created following cystectomy for muscle-invasive bladder cancer or other conditions requiring urinary diversion. 1 The most common type is an ileal conduit, where a segment of ileum is used to create the conduit with the ureters anastomosed to it and the distal end brought through the abdominal wall as the stoma. 1
Common Pitfalls
Inadequate preoperative stoma site marking leads to increased complications including difficulty with appliance adherence, skin breakdown, and impaired patient self-care ability. 1 The stoma should never be placed in areas of previous radiation, within surgical scars, or at sites where the patient cannot see or reach it. 2